Shared Governance and Transition into Practice: Impact on Work Shared Governance and Transition into Practice: Impact on Work Engagement Engagement

Practice Problem: High turnover rates, particularly in new graduate nurses, and poor organizational commitment and engagement negatively affect staffing, operational performance, and patient outcomes. A negative trend for nurse engagement indicators was noted in previous staff engagement surveys of this organization. PICOT: The PICOT question that guided this project was: In transition-into-practice (TIP) nurses (P), how does the implementation of shared governance (I) compared with no shared governance participation (C), affect their engagement with the hospital (O) within eight weeks (T)? Evidence : Literature has shown that nurse engagement is one of the nurse indicators positively affected by shared governance activities. The evidence supports the intervention and supplies a validated tool to assess the intended outcome. Intervention: Guided by the Johns Hopkins Evidence-based Practice Model for Nursing and the ADKAR change model, this evidence-based practice project created a shared governance council as a resource for the TIP nurse population and a platform for multidisciplinary collaboration on TIP-specific issues. Engagement in TIP nurses was measured with the Utrecht Work Engagement Scale-9 (UWES-9) at pre-and post-implementation time points. Outcome: The TIP Nurse Council was successfully implemented, with the council size increasing to eight members during the implementation period. Except for the lack of statistical significance in engagement scores and insufficient completion of pre-and post-implementation surveys by all TIP council members, all desired measures were met. Conclusion: Shared governance can be a valuable adjunct to strategies used to support early career nurses in transitioning to practice and being engaged with the organization.


Impact on Engagement
One of the most crucial problems the healthcare industry faces nowadays is workforce issues, like lack of engagement, often exacerbated by factors associated with the COVID-19 pandemic (Woodward & Willgerodt, 2022). Turnover rates accelerating the nursing shortage have reached levels that imperil patient safety and quality of care and threaten healthcare organizations' financial survivability (Bae, 2022). The shock of transitioning to an unfamiliar work environment contributes to the high number of new graduate nurses leaving their job (Ho et al., 2021).
Leaders in healthcare and university settings recognize that turnover and organizational commitment are affected by many complex issues within the work environment and have examined strategies to overcome preventable barriers (McClain et al., 2022;Taylor-Clark et al., 2022). Shared governance (SG) in healthcare is a structural framework that positively influences the professional practice environment and those preventable factors causing negative work experience (Porter O'Grady et al., 2022). Nurse engagement is one of the nurse indicators positively affected by SG efforts (Olender et al., 2020;Weaver et al., 2018;Sohal, 2020). This project proposes implementing an SG council focusing on transition-into-practice (TIP) nurses to improve nurse engagement and thus reduce nurse turnover (Quek et al., 2021).

Significance of the Practice Problem
Increasing nursing turnover rates and poor engagement with the organization negatively affect staffing, operational performance, and patient outcomes (Bae, 2022). Several latent issues place a higher burden on the nursing staff and exacerbate the existing workforce crisis.
These include the population's aging, increased chronic conditions of patients, impending retirements of baby-boomer generation nurses, exposure to workplace violence, nursing burnout, work-life balance demands, and new technological requirements (Haddad et al., 2020).
Annual turnover rates of nurses in the United States range from 19.1% (Taylor-Clark et al., 2022) to 27.65% (Nelson-Brantley et al., 2018). Globally, turnover rates vary along those numbers, with 15.1% in Australia or 23% in Israel (Bae, 2022). Also noteworthy is the intention to leave, which is predictive of actual turnover behavior . 23% of nurses indicated they intend to leave, and 29% are actively planning this soon (American Nurses Foundation, 2022). Due to transition shock, nurses in the first two years of practice are more likely than experienced nurses to leave their current job (Taylor-Clark et al., 2022). They often feel overwhelmed, unsupported, and without job embeddedness, community connections, or effective resilience strategies (Ho et al., 2021). Turnover rates in new nurses have increased threefold from 2006 to 2018, to 45.5% . Nurses born between 1980 and 2000 add 62% to the current US nursing workforce, though 30% express intent to leave within one year and 57% within two years (McClain et al., 2022). They intend to stay for an average job term of 2.8 years with frequent changes in roles and employers (McClain et al., 2022).
Low nurse retention is associated with work environment factors such as job satisfaction, engagement, and commitment (McClain et al., 2022). In this acute care community hospital, the annual employee engagement results for 2021 reported a negative trend for important nurse engagement indicators, like consistency with mission and values, the linkage of work to organizational goals, and the feeling of belonging to the workplace. The two most significant drops in the Press Ganey survey were an eight percent decline in intent to stay and a six percent decrease in sustainable engagement. The response to feeling a sense of belonging to the organization declined by 24% during the same period. Of the survey respondents, 41% felt disengaged, 18% detached, and 20% unsupported.
Evidence-based retention strategies for newer nurses include residency and mentorship programs (McClain et al., 2022). Due to a competitive position with other hospitals in town, recent graduates of this facility frequently change to other employers soon after completing their residency programs. Consequently, the difficulty of retaining nurses impacts continuity in providing care under high-census situations, causing temporary department closures.
Additional costs of recruitment and training of temporary and permanent nurse replacements and loss of intellectual capital and productivity are economic outcomes of turnover, affecting healthcare organizations' financial sustainability (Bae, 2022). Nurse turnover costs can range from $21,514 to $88,000 (Bae, 2022). The inability to hold on to nurses and provide safe, quality care can further negatively affect a facility's reputation and disrupt cohesion and morale among the remaining staff (Tang et al., 2019). Higher costs for healthcare operations are likely to increase consumer expenses (Bae, 2022).
Modern complex healthcare systems and COVID-19 post-pandemic realities increase new nurses' vulnerabilities Ho et al., 2021). In 2014, the professional practice environment was added as a fourth significant aim to the existing triple aim established by the Institute for Healthcare Improvement (Bowles et al., 2019). Nurse perceptions of work autonomy add to staff engagement (Hasselblad & Loan, 2022;Speroni et al., 2022). This facility's nursing operational agenda reflects the quadruple aim and targets stabilizing the workforce as a priority.

PICOT Question
In transition-into-practice nurses (P), does the implementation of shared governance (I) compared with no shared governance participation (C) affect their engagement with the hospital (O) within eight weeks (T)?

Population/Problem
Nurse turnover is increasingly affecting healthcare organizations' ability to provide safe, cost-effective care (Duru & Hammoud, 2022). Early career nurses are particularly at risk for turnover due to professional transition challenges (McClain et al., 2022). Individual, worksite, and organizational factors often influence the decision to leave (Jarden et al., 2021).

Intervention
Shared governance has positively impacted staff engagement, job satisfaction, and nurse retention (Dechairo-Marino et al., 2018;Quek et al., 2021;Kyytsönen et al., 2020). This project was intended to empower nurses to bring their personal experiences to a council designed to address their needs and effect change.

Comparison
The organization had few interventions in place to support novice nurses, and the existing SG structure did not include early career nursing needs.

Outcome
The desired outcome was increased staff engagement by TIP nurses, measured with the Utrecht Work Engagement Scale-9 (UWES-9), a validated tool (Schaufeli & Bakker, 2003), at pre-and post-implementation time points.

Timing
The project included the creation of a new SG council, recruiting TIP nurses as members, and their education on the shared governance model within eight weeks.

Evidence-Based Practice Framework
The Johns Hopkins Evidence-Based Practice Model (JHEBP), a linear problem-solving approach relevant to operational questions and responsive to internal and external factors, was applied to this project (Dang et al., 2022). This method follows the initial inquiry into the problem with the practice, evidence, and translation (PET) process to produce best practices and improvements. These three phases are iterative and dynamic, offering 20 steps and ten practice tools, refining the practice question, searching for the best evidence, and translating this knowledge to the practice setting (Dang et al., 2022). With this project, the problem step refined the question to include the application of SG and initiate stakeholder and team involvement. The evidence step sought literature evidence to analyze and decide on the best recommendations about professional practice governance to support this project. The final step translated the findings into an action plan to implement a TIP nurse SG council.

ADKAR Change Management Model
Successful realization of evidence-based knowledge benefits from active change management with structured processes and tools to guide the development and implementation of an actionable framework (Roussel et al., 2018). The Prosci ADKAR® Model, with the five change outcomes of awareness, desire, knowledge, ability, and reinforcement, operates on the premise that individual change drives organizational transformation (Prosci, n.d.). Therefore, this theory is an excellent choice for any evidence-based, innovative project built on leader buyin and employee empowerment (Mislan et al., 2021). Applied to this project, the actors and stakeholders became aware of the need to change with the resulting desire to improve the outcome of nurse retention. The plan involved all actors acquiring knowledge on changing and functioning in a novice-focused professional practice model and sustaining increased engagement.

Evidence Search Strategy
The PICOT elements guided the search for evidence. The keywords engagement, nurse engagement, workplace engagement, shared governance, shared governance councils, unit councils, professional governance, nurs*, nurses, and nursing, were applied to the initial literature review. It explored the PubMed, OVID Emcare, Cumulative Index to Nursing and Allied Health Literature (CINAHL) Complete, and ProQuest databases, yielding 7,430 papers.
Applicable MeSH terms include work engagement, nurses, nursing, nursing models, nursing shared governance, and professional governance. Limiting publication dates to less than five years and publication type to scholarly journals further reduced the results to 796 studies. After removing duplicates, title and abstract reviews for exclusion criteria rejected 749 articles because of non-English language and lack of specific relevance to the population or practice issue, like patient instead of nursing engagement. Inclusion criteria integrated any discussion of the impact of the implementation of a professional governance model or shared governance activity on nursing engagement or workplace environment. The remaining 47 articles were hand-screened to yield a final ten papers (Figure 1), selected for their usefulness in answering the PICOT question and critical appraisal results according to the JHEBP appraisal tool.

Results
A Prisma flowchart (Figure 1) summarizes the search process and results. The identification process through database and snowball searching provided a rich aggregate of articles for closer screening. Given the volume of over 7,000 records, a narrow limit of recent publications within five years and in the English language was applied, which allowed a review for eligibility of non-duplicate citations by title and abstract screening. These 761 citations were examined for applicable content according to keywords indicating discussion of the population, intervention, and outcome elements of the PICOT question. The focus on shared or professional nursing governance excluded studies describing professional practice activities and SG implementation in non-practice settings, like colleges. Papers about multidisciplinary councils, specialty disciplines, and outpatient settings were retained when they discussed engagement or related staff impacts. Since this project is not concerned with patient consequences, citations concentrating on patient safety or quality were excluded.
A final 47 full-text articles were thoroughly reviewed for strength and quality according to the JHEBP appraisal tool. Despite the filter of peer-reviewed publications, several articles provided descriptions of a quality improvement process, expert opinions, case studies, or otherwise failed to discuss research designs or outcomes. A poorly described procedure also affected three papers that explained the experience of creating novice nurses or night shift councils. Two further quantitative studies were excluded for low subject numbers. Several studies conducted in Asia and the Middle East were removed in favor of primarily Englishspeaking practice areas.

Evidence
This process left a final ten studies representing consistently strong evidence supporting the PICOT question (Appendix A). The appraisal is based on the Johns Hopkins research appraisal tool (Dang et al., 2022). Primary research evidence consists of a mix of qualitative and quantitative papers: Five articles were graded as level II (Dechairo-Marino et al., 2018;Hasselblad & Loan, 2022;Olender et al., 2020;Speroni et al., 2022), and three studies were found to be level III (Quek et al., 2021;Sohal, 2020;Weaver et al., 2018), with acceptable quality ratings of B for three studies and A or A/B grade for five papers (Appendix B).
These analyses include a longitudinal quantitative study, three quasi-experimental studies, one mixed-methods paper, one mixed-methods study of explanatory sequential design, one secondary analysis of a subset of a cross-sectional survey, and a prospective two-group comparative study. Three papers describe the assessment of work engagement as an outcome, with the Utrecht Work Engagement Scale (UWES) utilized by two authors (Olender et al., 2020;Quek et al., 2021). Two review articles offer some relevance to the PICOT question (Appendix C). One Scandinavian scoping review (Kyytsönen et al., 2020), level V, Grade B, was included due to a lack of recent assessments of shared governance evidence from English-speaking countries. Another paper, a systematic review of quantitative research, level II (Jarden et al., 2021), adds background on the PICOT outcome but is graded at level C. Together, these papers offer evidence that SG implementation improves engagement.

Themes with Practice Recommendations
The literature search strategy focused on the PICOT elements of intervention and outcomes. All primary research articles and the scoping review by Kyytsönen et al. (2020) examine the impact of SG implementation on staff outcomes as the central idea (Dechairo-Marino et al., 2018;Hasselblad & Loan, 2022;Olender et al., 2020;Quek et al., 2021;Sohal, 2020;Speroni et al., 2022;Weaver et al., 2018). Additional themes relate to the PICOT outcome of nurse or work engagement and non-staff impact, namely turnover and patient outcomes (Appendix D).

Perception of Work Environment
The selected literature revealed improved outcomes of work perception, staff satisfaction, autonomy, and shared decision-making. Weaver et al. (2018)  after adjustment for nurse characteristics. Speroni et al. (2022) found that SG outperformed traditional governance (TG) by 25% (p < .001) in the measured outcomes (nurse-sensitive indicators, patient and staff satisfaction) and raised staff satisfaction by 51.7%. Sohal (2020) revealed an improved culture of teamwork, morale, and knowledge of the professional practice model. Hasselblad and Loan (2022)

Engagement
Three quantitative papers (Quek et al., 2021;Sohal, 2020;Olender et al., 2020) investigated the relationships between SG and work, staff, or nursing engagement. Sohal  over time. Work engagement was statistically significantly related to nurse empowerment (r = .668, p < .001) and caring (r = .295, p < .001). The lack of sustainable increases in work engagement points to the need to set long-term goals after SG's initial implementation. Quek et al. (2021) found a statistically significant (p < .001) rise of 10% in nurse engagement after SG implementation.

Intent to Stay
A systematic review of new graduates' well-and ill-being predictors by Jarden et al.
(2021) addressed turnover intention and showed that work engagement was a positive indicator of the intent to stay for new nurses. This study was included to provide additional background on PICOT outcomes and the focus on the target population, but the low-quality grade due to poor study standards limits the usability of the outcomes. The only quantitative study used that also investigated intent to stay demonstrated statistical significance for the association of SG implementation (p = .001), and the addition of distributed leadership agency produced a statistically significant raise (p = .001) (Quek et al., 2021).

Patient Outcomes
Sohal (2020) included a nurse-sensitive quality metric in the project aim and found a significant downward shift in patient fall rates with the initial implementation of SG. A refresh of the SG model produced another reduction from three to zero over the implementation period (Sohal, 2020). Speroni et al. (2022) examined patient satisfaction and observed that SG models outperformed TG significantly for 11.1% of the categories assessed. Separating the U.S. from international facilities generated no significant difference in nurse-sensitive indicators between SG and TG models, which led the authors to suggest shared governance as a strategy for leaders to improve select nurse-related benchmarks (Speroni et al., 2022).

Summary of Recommendation
Improved perceptions of shared decision-making, staff satisfaction, and autonomy related to SG were documented with quality grades of high Hasselblad & Loan, 2022;Quek et al., 2021;Speroni et al., 2022), high/good (Dechairo-Marino et al., 2018), and good (Olender et al., 2020;Sohal, 2020;Weaver et al., 2018). Engagement outcomes were detailed with quality grades of high (Quek et al., 2021) and good (Olender et al., 2020;Sohal, 2020). The UWES assessment was presented as a validated tool to measure work engagement (Quek et al., 2021;Olender et al., 2020). While turnover intention and patient outcomes did not show consistent significant associations with SG practice, they were not the primary results investigated. As such, a case cannot fully be made about its usefulness in those situations.
Aside from the review by Jarden et al. (2021), the quality of the studies involved in these outcomes is good or high. The studies presenting the evidence reflect the intervention and the PICOT population. Some studies differed in assessing newly created Hasselblad & Loan, 2022;Sohal, 2020;Weaver et al., 2018) versus refreshed SG models. The UWES tool was used to measure work engagement outcomes (Olender et al., 2020;Quek et al., 2021), whereas the IPNG survey was the tool mainly used to assess council development (Dechairo Marino et al., 2018;Speroni et al., 2022;Weaver et al., 2018).
Despite variations, the research showed that the strength of the evidence presented is of good quality to support the intervention and supplied a validated tool to assess the intended outcome with the UWES-9 survey tool. Thus, it answered the PICOT question: In transition-to-practice nurses (P), does the implementation of shared governance (I) compared with no shared governance participation (C) affect their engagement with the hospital measured by UWES-9 (O) within eight weeks (T)?

Setting and Stakeholders
The project was implemented in a 278-bed acute care hospital with a 4-star rating in a faith-based healthcare system. The organization strives for high-reliability behaviors in its operations and culture. Its structure consists of chief executives at divisional and local levels accountable to a board of trustees. Its Catholic mission of steadfast service to all envisions health for a better world and promises to know, care for and ease the way of all patients, families, and caregivers. Annual employee surveys have demonstrated poor employee engagement and worsening staff turnover. The organization prioritizes stabilizing the workforce, making the project timely and endorsed by leadership. This support was verified in several meetings with the chief nursing officer (CNO), managers, educational department specialists, and SG leaders, who constituted the major stakeholders. The other stakeholders were the transition-into-practice (TIP) nurses, active or recent graduates from the facility's residency program, invited to join this new council at the start of the implementation of the project.
The DNP student functioned as the project lead (PL) to develop the council structure with the TIP council and collaborate with all stakeholders. The PL facilitated the alignment of this council with the existing SG model and evidence-based knowledge on nursing governance.
Unlike the overall SG structure, which includes peers from other disciplines, this council was designed for nurses. Including non-nursing partners as ad-hoc members at council meetings fostered interprofessional collaboration and familiarized the council members with the various professional partners in the facility. Integrating learnings from the first cohort and stakeholders with a clear succession plan aided sustainability.

Strengths, Weaknesses, Opportunities, and Threats (SWOT) Analysis
An organizational assessment revealed positive and negative issues caused by internal sources and external forces, represented in a SWOT analysis (Table 1). Significant factors backing this project included internal support and expertise by leadership to increase staff buyin, engagement, and satisfaction and decrease turnover intention, especially by nurses not yet embedded in the organization. Strengths were endorsements by executive and core leaders, educators in charge of the hospital's residency program, and SG leaders. Other strengths were the existing SG model with proven successes, the organizational objective to stabilize the workforce, the system's promise to care for its staff, and improved dialogue with caregivers.
Opportunities offered recruitment incentives, professional development, and enhanced staff satisfaction, with attention to nursing needs. The opportunities to boost nursing engagement and decrease turnover as outcomes were of particular interest.
Weaknesses included the overall lack of staff engagement, ownership, and participation in councils, reduced financial resources, staffing shortages, resistance to change, and meeting restrictions. Poor morale, lack of employee participation, and resistance to change were possible impediments to successful outcomes. Threats were the nursing shortage overall, compounded by market competition, staff attrition, and a seasonal patient surge. Other threats came from implementing a new council with limited prior experience and recent negative media coverage of the system.

System Change
Socio-institutional theories in healthcare settings describe systems' micro, meso, and macro levels (Sawatzky et al., 2021). The micro level symbolizes the caregiving frontline units, the meso level embodies infrastructure and organizational decision-making areas, and the macro level represents the policy and regulatory environments (Sawatzky et al., 2021). This project presented the opportunity to create change at the micro, meso, and macro system levels. Creating a TIP council with nurses from different care areas or micro levels represented a meso level change. The council members acted as unit representatives to their peers in the various departments, creating micro and meso level changes in the facility. Further expansion across the healthcare system on the macro level is possible.

Implementation Plan with Timeline and Budget
Project Objectives 1. The PL facilitated a new SG council for the TIP nurses, as evidenced by two TIP council meetings held during implementation.
2. The PL and SG mentors educated the TIP council nurses in the first meeting on SG principles and structures.
3. The engagement of TIP nurses was expected to rise by 5%, assessed by pre-and postcouncil implementation survey results conducted by the PL.
4. The council's sustainability was improved through meeting structure and content development, as evidenced by a charter and a draft outline of the monthly meeting agendas within eight weeks of implementation.

Implementation Plan
The translation phase of the JHEBP framework guided the project management and application of the JHEBP action plan tool (Dang et al., 2022) (Prosci, n.d.). Following these steps offered a logical structure for the project implementation activities and timeline (Appendix E).

Awareness
This milestone informs stakeholders of the need for change, creating awareness on the leadership level to ensure organizational support. Following executive endorsement, current SG and interprofessional leaders, managers, and C-suite were included in communications about this project. The PL connected with TIP nurses through educational leaders, conveying organizational support for change and enabling real-time dialogue with stakeholders. Attending unit meetings informed staff members of the micro-level system of this project.

Desire
Fostering the desire to be a part of change goes together with raising awareness. The PL explained the why for the change, was specific, and included the impact, opportunities, and potential concerns and barriers. The strengths and opportunities identified in the SWOT analysis were added. Individualizing arguments and information according to the audience and including the benefits of participation increased engagement and influence on the work environment and were used to appeal to stakeholders to support the project.

Knowledge
This milestone offers education and actionable skills. Stakeholders were educated in implementing this project, and TIP council members were oriented to SG processes, meeting management, and their role at an inaugural workshop. The PL facilitated the group's learning, with independence as the primary goal for the TIP council.

Ability
Making and maintaining a change is crucial for adoption at both the meso and micro levels. Waning leadership support and a lack of consistent structure are critical failure causes in SG efforts (Kyytsönen et al., 2020). Adding experienced SG mentors, education and leadership sponsors, and C-suite attendance to the TIP council enabled immediate and direct communication and change agency.

Reinforcement
Delegating accountability for refining meeting structures and content and creating a council charter added to the TIP council's commitment to this SG activity. Continued leadership support aided the sustainability of this council. Based on the literature findings, the UWES-9 tool was used to evaluate the project's impact on the PICOT outcome.

Project Schedule
The PL obtained institutional and facility review board approval before the beginning of the project and kept project sponsors and stakeholders informed throughout implementation.
• Week 1-2: The PL introduced the project at unit and residency program meetings to create staff awareness, recruit members, and obtain budget approval.
• Week 3: An introductory workshop provided SG education and updates for all interested stakeholders and the TIP council members. The PL collected the UWES-9 survey at the beginning of the workshop.
• Week 4: At the first TIP council meeting, members initiated the development of council documents and meeting strategies.
• Week 5-6: The PL supported council members and informed sponsors of the progress.
• Week 7: The members refined the succession plan and completed a postimplementation UWES-9 survey at the end of the second TIP council meeting.
• Week 8: The implementation was completed. The PL shared a report with stakeholders.

Budget
Administrative approval was granted to fund this project from the SG cost center. The main expenses arose from personnel costs for workshop and meeting attendance; training materials and mileage expenses added minor costs (Table 2).

Data Collection
The PICOT question assessed the impact of SG implementation on work engagement in a TIP nursing council. Implementation began after approval by the evidence-based practice review committee (EPRC) from the University of St. Augustine for Health Sciences (USAHS) and the facility's institutional review board (IRB) was obtained. The initial data collection plan proposed paper surveys collected at in-person meetings. The council participants requested meetings to be held remotely, which necessitated the survey to be converted into an electronic version with a digital link offered to the participants. The university and institutional reviews approved the change in the data collection method before data collection began. All surveys were completed anonymously, which maintained data integrity and security. To match pre-and post-intervention answers, the last three digits of the employee ID were used. Data was stored on the facility-owned files network and only accessible to the PL.
All TIP nurses participating in this council were included in the survey. At the beginning of the workshop meeting, the rationale for and the process of survey collection and data safety was explained, with the opportunity to complete the survey at that time. The post-intervention survey was offered at the end of the second council meeting. After the initial recruitment of seven potential council members, the council member size increased from seven to eight nurses during the implementation period. The three meetings saw varied attendance, which impacted survey completion.

Evaluation Tool and Design
The data was collected through a pre-and post-implementation assessment using a validated survey tool, the UWES-9 questionnaire, with established factorial validity, internal consistency, and test-retest reliability (Schaufeli et al., 2006). This self-reported 9-statement work and well-being survey measures the three work engagement dimensions of vigor, dedication, and absorption via a 7-item Likert scale from never to always (0 to 6) (Schaufeli & Bakker, 2003). Permission to use the tool was granted for non-commercial academic purposes, provided data were shared with the tool owner, including raw test scores, age, gender, and (if available) occupation, and the original order and format of questions were followed (Schaufeli, n.d.). To describe participants effectively and comply with the tool owner's permission conditions, demographic data by age brackets and gender was collected (Table 3).

Data Analysis
Seven participants completed the pre-intervention survey, six answered the postintervention survey. Two pre-implementation responses and one post-intervention answer could not be matched to the corresponding identification code and were omitted from the analysis, leaving five participant data for inclusion in the analysis via the Intellectus Statistics software program (Intellectus, 2022). A two-tailed paired samples t-test was conducted to examine the pre-and post-implementation engagement survey outcomes (Table 4). The pre-implementation mean (µ=4.31) compared to the post-implementation mean (µ=4.36) showed that the results were not statistically significantly different (Table 5). A Shapiro-Wilk test was conducted to test for the normal distribution of data, which indicated the normality assumption was met based on an alpha value of .05, W = 0.94, p = .666 (Figure 2). A two-tailed Wilcoxon signed rank test was added as a non-parametric alternative. Based on an alpha value of .05, V = 2.00, z = -.53, p = .593, it indicated that the differences in results (pre-intervention Mdn = 4.56, and postintervention Mdn = 4.78) were explainable by random variation (Figure 3).

Outcomes
The sample size (N=5) and short implementation period limit the statistical significance and made inconclusive data outcomes likely. In addition, clinical significance is useful in practice when statistical significance is not present (Kim & Mallory, 2016), as is the case with this project. Of clinical significance is that the council was created, stayed active, and the member number increased during the implementation period. After the orientation workshop, the two initial council meetings were held despite the short implementation time and were aligned with the overall SG meeting schedule. During the meetings, the participants created a council charter and agenda based on the hospital's SG model and decided on goals to accomplish by the end of the year.  Table 6. All measures were met except for the lack of statistical significance in engagement scores and insufficient completion of pre-and postimplementation surveys by all TIP council members.

Impact
The project assessed the impact of SG participation on engagement in the TIP nurse population through the creation of an SG council. This hospital has experienced a repeated decline in staff engagement rates and increased turnover, especially among nurses at the beginning of their careers. The project successfully implemented a TIP nurse council using evidence-based practice for shared decision-making. The council presented a new and formal platform for TIP nurses to convene and collaborate on issues of particular importance to TIP nurses, in alignment with the existing SG model. Despite the lack of statistical change, clinical significance exists through the opportunity for active engagement as a TIP council member. The clinical impact of the project was confirmed by TIP council member statements. They indicated that this is a resource for all TIP nurses in the hospital for networking, support, a sense of community, belonging, and understanding of what the organization has to offer. The new practices created through this project involved the council's participation in the annual hospital week celebration and its collaboration in creating a council intranet site and onboarding presentations for TIP nurses. Council members repeatedly expressed satisfaction and an optimistic view of the opportunities, their role on the council, and their potential positive impact on other TIP nurses.

Barriers and Limitations
The main barriers to the initial implementation and future continuation of this project are related to the voluntary participation of staff who experience a stressful transition to practice, and the problem of timely connection with the target population. The recruitment of initial council members involved various and repeated methods of communication such as emails directed to clinical academy participants, announcements in unit meetings and at manager rounds, educators and SG leaders, and fliers posted in units. There were seven meetings offered to introduce the project and subsequently find convenient meeting times for all interested participants on short notice. Another obstacle was the lack of familiarity of TIP nurses with the concept of shared governance. While the orientation workshop was helpful in introducing the model as practiced at this hospital, council members found the opportunities it presented for professional engagement for TIP nurses less obvious and somewhat abstract.
The slow process of recruiting council members, the time constraints for this project, and the varying attendance and membership at the initial meetings affected the evaluation methods and survey completion. The pre-and post-intervention survey conducted at this time was restricted by small participation numbers, leading to a small number of surveys included for analysis (N=5). This limited the ability to interpret evaluation data for outcomes.
A concern for sustainability is the transitioning of council leadership. This was addressed through the addition of experienced colleagues, champions in mentorship, professional practice, and shared governance who will continue to support the council members. One TIP nurse has committed to assuming the council chair role and is mentored by the PL.

Future Implications for Practice
Repeating the UWES-9 survey, and adding an established council health assessment instrument, like the one by Hess and colleagues (2020), will further validate the clinical and possibly also add statistical significance to the outcomes. Based on the clinical impact, SG will be a valuable addition to the strategies used to support early career nurses transitioning into practice. SG participation will encourage engagement with the organization given ongoing support and adjustments. If further assessments demonstrate more value, then this SG activity can be expanded to more hospitals in the system, and include other disciplines as supported by leadership.

Dissemination Plan
The dissemination plan includes internal and external sharing of results. Within the facility, in-person or virtual presentations using PowerPoint demonstrations with video and voice-over were well received. The project was presented at the facility-wide shared governance council, the TIP council, and professional development and leadership meetings within three months after implementation was completed since the facility lacks an evidence-based practice committee.
External dissemination includes an oral poster presentation to faculty at USAHS and the paper submission to SOAR@USA, the university repository for scholarly student works. The PL has submitted an abstract to the hospital organization's South division nursing research conference for poster and PowerPoint presentation and was accepted for a podium presentation later this year.

Conclusion
This project sought to address current workforce problems related to nursing turnover and poor work satisfaction. The facility's leadership endorsed this project, and possible stakeholders were identified. The project intended to raise the engagement of the nursing group most vulnerable to turnover, nurses transitioning into practice (TIP). By creating a professional practice platform for SG activity, these nurses have been provided the ability to connect as a group and access significant stakeholders and leaders of the organization. An eight-week implementation was planned after IRB approval was granted and led to the creation of a hospital-wide SG council for TIP nurses. The project applied evidence-based knowledge about SG practice and its impact on workplace experience and staff engagement. The PET process of the JHEBP model as an evidence-based practice framework and the ADKAR change management model offered the conceptual foundations to support the change. This experience enabled the embedding of TIP nurses into the culture of this facility through a dialogue and decision-making venue and the formal appreciation of their professional insights and needs.
While the small survey sample size and short implementation period limited statistical results, TIP nurses' participation in this council demonstrated shared governance activities as a valuable adjunct to support early career nurses in transitioning to practice and being engaged with the organization.       Studies included in synthesis (n=10)

Figure 2
The means of Pre-Implementation (Engagement Pretest) and Post-Implementation (Engagement Posttest) with 95.00% CI Error Bars