الفهرس 
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Abstract
Shared governance offers a vital communication and decision-making infrastructure which is an important element for a professional practice environment. A shared governance environment in hospitals guarantees that nurses are more involved in decisions regarding their practice which improves their work engagement. SG and work engagement occur through an environment of fairness and justice related to error reporting which is known just culture, that encourages quality, safety over immediate punishment and blame, as well as creates safer environments for patients and individuals to receive services and give a sense of ownership to nurses and other workers in the process.
Aim of the study:
This study aims to investigate nurses’ perception of SG and its relation to work engagement and just culture at Alexandria Main University Hospital.
Setting:
This research was conducted in Medical, Surgical Inpatient Care Units, and their specialties with bed capacity 1370 beds and Critical Care Units with 147 beds capacity at Alexandria Main University. Medical Inpatient Care Units and its specialties include 24 units, Surgical Inpatient Care Units and its specialties include 17 units, and Critical Care Units include 4 units.
Subjects:
Convenience sampling was used for collecting data. It includes nurses (n=270) who were working in previously selected settings with experience at least one year, and were available during the time of data collection and classified as Medical Inpatient Care Units =86 nurses, Surgical Inpatient Care Units=130 nurses and Critical Care Units =54 nurses.
Tools:
Three tools were used in this study.
Tool (1): Index of Professional Nursing Governance (IPNG):
IPNG questionnaire was developed by Hess in (1998) and updated in (2011), to assess the degree of professional nursing governance as perceived by nurses on a continuum from traditional, to shared, and self-governance. It includes 86 items divided into six main dimensions namely; control over professional practice (16 items), influence over resources (13 items), control over personnel (22 items), participation in committee structures (12 items), access to information (15 items), and ability to set goals and conflict resolution (8 items).
The response was measured on a 5-point Likert scale that ranged from 1 to 5, as follows: 1 = nursing management/administration only, 2 = primarily nursing management/ administration with some nurses input, 3 = equally shared by nurses and nursing management/ administration, 4 = primarily nurses with some nursing management/ administration and 5 = nurses only.
The scoring of IPNG, range from 86-172 of total scores reflecting (traditional) management decision-making environment. An environment that utilizes professional nursing shared governance decision making between nurses and management was an IPNG range of 173-344. If nurses are the decision-maker group (self-governance) IPNG range was from 354-430.
Tool (2): UTRECHT Work Engagement Scale (UWES):
It was developed by Schaufeli and Bakker in (2002) and updated in (2006). It is used to measure the work engagement levels of participating nurses. It consists of 9 items classified into three dimensions namely: vigor, dedication, and absorption. Each dimension is composed of three items. For purpose of ease response, the scale was adapted from a seven-point Likert scale to a five-point Likert scale ranging from (0) never to (4) always. There is no reversed score. The overall score level range from (0 to 36). Lower scoring of work engagement range from (0 -11), moderate scoring of work engagement range from (12-23), and higher scoring of work engagement range from (24 -36).
Tool (3): Just Culture Assessment Tool (JCAT):
The JCAT was developed and validated by Petschonek (2011). It is designed to measure the levels of nurses’ perceptions of fairness and justice as it relates to error reporting. It consists of 31 items classified into six dimensions namely: feedback and communication (Top Down) (4 items), openness of communication (Bottom-up) (4 items), balance (No punitive and Accountability) (7 items), quality of the error-reporting process (5 items), the overall goal of continuous improvement (5 items), and trust (6 items). For ease response, the scale was adapted from a seven-point Likert scale to a five-point Likert scale ranging from (1) strongly disagree to (5) strongly agree. The reversed score was applied for negative statements. The overall score level ranging from (31to 155). Lower scoring of Just Culture range from (31 - 71) moderate scoring of Just Culture range from (72-113) and higher scoring of Just Culture range from (114-155).
In addition, nurses’ demographic sheet was developed by the researcher to collect data for nurses include age, gender, marital status, level of education, working units, years of experience in nursing career and years of experience in current working units.
Method
1. Official permission was obtained from the Faculty of Nursing, Alexandria University, and the hospital administrators at Alexandria Main University hospital to collect the necessary data.
2. Tool II, III were translated into Arabic and tested for validity by five experts from the Faculty of Nursing, Alexandria University.
3. Tool I, II, III were tested for their reliability by using statistical tests to measure the internal consistency using Cronbach’s alpha correlation coefficient test. The result of the three tools revealed that they were reliable with the value of r=0,.980. for professional nursing governance, 0.928 for work engagement questionnaire, r=0.772 for just culture questionnaire.
4. A pilot study was carried out on 10 % of nurses (n=27) rather than the study subjects.
5. Data were collected for this study by the researcher through a self-administered questionnaire. The data was collected in two months from 12-10-2019 to 12-12-2019.
6. Ethical considerations were assured.
Result of the study showed that:
The present study revealed that more than half of the studied nurses (64%) practice the first level of nursing SG (236.40±69.481) as the nursing profession related decisions were taken primarily by nursing management with some staff nurses input.
Also, this study indicated that more than half of the studied nurses (61.5%) perceived as high mean percent score of overall work engagement (69.98%) represented in all dimensions.
Besides, more than half of the studied nurses (52.2%) perceived a high mean percent score of just culture (68.28%) represented in all dimensions.
There was a positive low statistically significant correlation between SG and work engagement. While there was a positive moderate statistically significant correlation between SG and just culture. Also, there was a positive low significant correlation between just culture and work engagement.
This study revealed that SG as the independent variable is a predictor for work engagement and just culture as dependent variables.
The findings of this study lead to the following recommendations:
Recommendations for administrators
1. Provide nurse managers training programs, workshops, and conferences that concentrate on SG practices and interpersonal skills as the most effective and efficient way to improve organizational success.
2. Enhance a healthy work environment with open communications through conducting a schedule for staff meetings and workshops with their managers to enhance and improve the managers’ ability to consider work engagement.
3. Build mutual trust among administrators and nurses through, treating them fairly, giving them adequate time, as well as equally allocating resources and opportunities such as new devices or training programs and opportunities for promotion.
4. Provide monthly bulletins to all staff reminding them of issues that could affect their work performance as well as patients’ safety.
Recommendations for first-line nurse managers
A. First-line nurse managers should implement empowering strategies such as SG that allow nurses to have control over their nursing practice and promote quality nursing care by providing education, and training for SG skills that should be available for all nurses.
B. Develop the skills of both FLNMs and nurses in communication, collaboration, goal settings, teamwork, conflict management, and decision-making process, that are important for SG.
C. Develop and implement change strategies that will improve nurses’ work engagement such as flexible schedules, clear communication and feedback, and fair treatment of all nurses in the units.
D. Motivate nurses through constructive reward and recognition for their contributions through verbal encouragement or recommended for promotion.
E. Provide a supportive work environment where both FLNMs and nurses must work together to solve issues by openly discussing the obstacles and barriers that exist in the work process and where nurses feel that they can question existing practices, express concerns, ask for help, and admit errors without suffering ridicule or punishment.
Further researches
Examine the relationship between nurses’ work engagement and patient outcomes.
Assess the shared governance perception among all staff nurses levels and its relation to staff commitment, empowerment, or citizenship.
A comparative study to identify factors that affect the presence of just culture between nurses in governmental and private hospitals.