Are you a nurse with a desire to impact policies, procedures, and patient care processes? Does being part of a practice model that promotes nursing empowerment through shared decision-making interest you? If so, you may find that shared governance in nursing could benefit you. Maybe you are wondering, "What is shared governance in nursing?" If this sounds like you, this article is for you! As you continue reading, you will learn what shared governance in nursing is, the 10 benefits of shared governance in nursing, and examples of how to implement shared governance in practice.
Shared governance in nursing is a nursing practice model that integrates core values and beliefs embraced by professional practice to pursue and achieve quality care. It is a working model characterized by participatory decision-making in which nurses and other interdisciplinary team members follow organized decision-making processes regarding quality improvement, practice standards, professional development, and research. Tim Porter-O'Grady, a shared governance pioneer, defines shared governance as "a structural model through which nurses can express and manage their practice with a higher level of professional autonomy.”
Shared governance in nursing was originally introduced in the 1970s and 1980s. However, its popularity waxed and waned for a brief period. Nursing shared governance was popularized in 1985 with the publication of Shared Governance for Nursing: A Creative Approach to Professional Accountability, which Porter-O'Grady co-authored. Today, shared governance is considered the most preferred leadership model by transformational leaders in nursing and throughout healthcare.
Shared governance in nursing is a professional practice model that promotes shared decision-making and nursing empowerment by making nurses accountable for decisions impacting processes, policies, and procedures at the point of patient care. The nurse’s role in shared governance is to utilize clinical expertise and knowledge to help find solutions to problems or issues within their department or organization, acting as part of a council or team.
There are several types of nursing shared governance models. Each hospital or healthcare organization determines which models are most appropriate to meet their needs. Smaller organizations may implement only one model, while larger corporations or healthcare facilities may use several, depending on their needs and goals. The following are examples of the four most common models of shared governance in nursing.
This type of nursing shared governance model is tailored to a specific nursing unit. The purpose of Unit-Based shared governance is for nurses and nurse leaders to work together to make clinical and business decisions relevant to the delivery of nursing care in their respective unit(s).
The council model of shared governance in nursing uses any number of department-level councils to coordinate administrative and clinical activities. This model is the most popular shared governance in nursing model. This model allows nurse-directed councils to develop and implement nursing practice. With this model, management's role is primarily supportive and facilitative, with practitioners at the point of care guiding and directing nursing practice. Councils include evidence-based practice, recruitment and retention, clinical practice, and unit-based councils.
This model of nursing shared governance reflects a level of executive coordination overseeing the activities of smaller councils.
The congressional model of shared governance in nursing involves the central collaboration of members across the healthcare organization. The members meet as one council. The congressional model is the model where all nursing staff belong, and work is assigned to cabinets. Although this model is not used as frequently as others, some research indicates satisfaction with this model is similar to the satisfaction level of those participating in the council model of care management.
Whether you are familiar with the concept of shared governance in nursing or this is a new concept to you, you will find that the benefits outweigh any drawbacks. Let's look at the top ten benefits of shared governance in nursing.
Shared governance in nursing increases nurse engagement in all aspects of decision-making and patient care. Engaged nurses working together to achieve a common goal positively impact patients, nursing and interdisciplinary teams, and the organizations they work with.
One of the benefits of shared governance in nursing is that it allows healthcare administrators to optimize the efficiency of healthcare services.
The goal of all nurses is to provide high-quality patient care that improves patient outcomes. One of the most significant results of shared governance in nursing is improved patient outcomes. Studies indicate improvement in the number of nursing-sensitive issues such as hospital-acquired pressure ulcers, catheter-associated urinary tract infections, central line-associated infections, and falls with injuries.
Shared governance creates opportunities for nurses to see their ideas in action within their work environment. This makes nurses feel like their knowledge and skills are valued and appreciated, thereby increasing job satisfaction and their sense of belonging.
When nurses feel satisfaction and a sense of belonging, they often feel a greater sense of loyalty to their employer or organization. Their loyalty results in increased nurse retention.
Shared governance in nursing allows nurses to network with peers and supports collaboration among nursing units, facility departments, and healthcare team members. Communication and collaboration lead to better relationships between nurses and other interdisciplinary team members.
Shared governance has proven to be an effective way of handling issues related to patient care. When committees or councils work together with facility staff to implement measures based on shared decision-making and solid, evidence-based practices, patient outcomes improve, which is one of the benefits of shared governance in nursing.
When patient outcomes improve, patient satisfaction increases, resulting in better patient satisfaction scores. These scores are important as they are considered when hospitals and other healthcare organizations seek funding for equipment, additional staff, or other organizational needs.
Healthcare facilities and organizations that use a shared governance model of nursing tend to have lower rates of spikes in healthcare costs. It may be attributed to the fact that shared governance considers ideas from teams who develop and implement measures to promote high-quality, more cost-effective care.
Participation in shared governance involves active learning. As nurses learn and grow, they can move from being members of a council to chairperson. This type of growth benefits healthcare organizations and employers because employee growth means they can promote from within the company.
Magnet status is the highest credential nursing facilities in the United States and worldwide can obtain. Medical facilities must meet the criteria to measure nursing excellence as established by the American Nurses Credentialing Center. Work environment, nursing excellence, quality patient outcomes, and innovations in nursing practice are considered. Another fundamental requirement of medical facilities applying for Magnet status is demonstrating an effective model of shared governance.
The shared governance in nursing model is popularly utilized. However, like any model, it is not perfect. The following are a few examples of drawbacks of shared governance in nursing.
1. Shared governance in nursing often requires an increased level of work and greater time commitment, making it a less attractive option for bedside nurses who already work long hours.
2. In matters of nursing education, one drawback of nursing shared governance occurs when faculty committee members disagree about methods of research and classroom instruction. In some cases, one faculty member may desire to utilize strategies that others feel are inappropriate or controversial. In these instances, the shared governance model would allow the majority to stop the faculty member from implementing his preferred strategies.
3. Despite the many benefits of shared governance, it is not uncommon for some members of shared governance councils or committees to become inactive, creating internal imbalance and conflicts. When this occurs, the committee's goals may be delayed, or poor outcomes may result.
Shared governance in nursing is characterized by eight main principles: ownership, accountability empowerment, teamwork, leadership, innovation, practice equity, and autonomy. The following are brief descriptions of the principles of shared governance.
Ownership refers to recognizing and accepting the impact created by the contributions of individuals and their collective work. In other words, everyone involved in shared governance must commit to investing in the process of shared governance and accept responsibility for their own contributions. In shared governance, instead of nurses referring to "their patient" or "their assignment," the natural progression of the shared governance requires nurses to translate those phrases into "their practice."
Accountability is a willingness to take ownership of one's practice decisions that support partnerships that improve patient and organizational outcomes. Accountability is supported by an outcome-based review, implementation of proper actions within each practice role, and provision of a collaborative environment that fosters and supports teamwork.
Empowerment relies on solid partnerships. It is value-driven and impacts everyone involved in the process. Empowerment refers to access to resources and appropriate psychological responses to those resources. It is defined as the autonomy and authority to influence or make decisions about clinical practice.
Teamwork is the fundamental building block of interprofessional decision-making. Each nurse has a role in supporting and actively engaging in efforts to meet the vision, values, and mission of the healthcare organization's plan. Effective teamwork increases connections and staff engagement. Teamwork helps each member understand the perspectives and rationale of other team members, leading to better understanding and stronger interprofessional relationships.
Leadership qualities are the outcome of active participation within the nursing shared governance models. In fact, by participation in shared governance, each nurse assumes a leadership role. When employers offer leadership training, resources, and tools combined with mentorship, it creates an environment conducive to developing advanced leadership skills and qualities.
Innovation is associated with a spirit of inquiry. In shared governance in nursing, nurses are involved in all aspects of patient care and organizational practices. This involvement fosters innovation, resulting from having the confidence and ability to lead others and seek new solutions and ideas. Having a mind of innovation leads to higher levels of evidence-based practice and promotes research investigation, which positively impacts patient outcomes.
Practice Equity ensures that all members of the patient care team realize their contributions are valuable and necessary to drive positive patient outcomes. Equity and equality in terms of knowledge, responsibility, authority, and scope of practice are not the same. However, practice equity acknowledges that each team member plays an essential role in providing effective, safe patient care and that their contributions are necessary.
Autonomy is referred to as self-governance. It is the nurse's ability to influence practice and their workplace. Nurses must understand that autonomy is not possible without equity and a balanced environment. Action planning through shared governance in nursing councils enhances autonomy by giving nurses the responsibility and authority to make decisions about their practice.
Developing a shared governance mindset takes time and dedication. It is necessary to plan thoroughly before putting shared governance into action. The following are 10 steps involved in successfully implementing shared governance in nursing.
All nursing shared governance models should have a steering committee. The steering committee should represent nurses from all clinical areas and nursing roles. Diversity among committee members helps to ensure the perspectives of nurses from all levels are represented.
Each council should have membership criteria to ensure invitations are extended to those most appropriate to fill the membership role.
Although the goal of shared governance in nursing is to have a team approach to decision-making, there remains a need to have a spokesperson(s) to bring ideas or concerns to the appropriate department head. Therefore, once a committee is established, facility administrators may opt to appoint a chair and co-chairs or allow the committee members to vote.
Some organizations ask for staff nurse volunteers, while others choose to hold an election to determine council members. A few examples of types of shared governance councils include unit-based councils, specialty nursing councils, coordination councils, and leadership councils.
Each committee exercising shared governance should have a mission statement relevant to the needs and goals of their unit or organization. In most cases, each committee member makes suggestions for what should be included in the mission statement; then, the committee-appointed or elected chair and co-chairs create a final draft for approval by members.
Bylaws are the governing rules by which an organization operates. It is essential to establish bylaws before implementing any shared governance nursing model. Bylaws for shared governance should include determining the maximum number of members, meeting schedule and cadence, term limits for members, plans for member turnover, and a written policy of confidentiality and open communication. Additionally, the bylaws should include guidelines for bringing issues to the council for consideration.
Once the type of nursing shared governance model is determined, nurses in the relevant clinical area should be educated about the purpose of the model and their role in implementing shared governance.
As with any successful organization or committee, there should be clear guidelines for how issues are presented to the council, the anticipated timeframe for having the issue addressed, and how decisions will be made announced.
Depending on the type of organization where shared governance is implemented, committee or council members may work alternating shifts or opposite shifts from one another. Establishing a preferred method of communication allows team members to know the expectations for communication and what to anticipate regarding responses to communication.
Establishing protocol and implementing measures to promote shared governance in nursing requires work. Timelines may differ depending on your organization's nursing culture and its willingness to accept change. It is essential to set reasonable timelines which allow for appropriate planning and implementation to ensure success.
There are several examples of shared governance in nursing, and each can be tailored to a specific department, specialty, or patient population. The following are five examples of ways to implement shared governance in a hospital setting.
Emergency room nurses at St. Mary's Hospital voice concerns about overcrowding and compromised patient privacy due to a lack of space to handle an increase in the number of patients.
Emergency department nurses and nurse leaders meet and discuss measures to improve workflow in the ER and options for opening unused areas of the hospital near the emergency room for ER needs. For example, some nurses suggest using a smaller wing close to the emergency room for intake and triage. Other nurses feel rearranging the set-up in the open area of the department could create space for more beds and equipment, including adding more privacy curtains between patient stations.
Without input from emergency room nurses, the seriousness of the depth of need may not be as clear. The nurses who work in the emergency department experience the effects of overcrowding and lack of space to perform care firsthand. While nursing administration may desire to improve the situation, a lack of shared governance to address the issues may cause oversight and prevent resolution.
If an employer gives an assignment to a nurse, it is the nurse's responsibility to determine if that assignment is within their scope of practice before accepting or rejecting it. When an assignment is believed to be outside the scope of practice, the nurse should consult with management to determine the appropriate course of action to ensure patient care continues with a nurse whose scope of practice allows the type of care needed.
For example, Glenoaks Medical Center's nursing administration has identified an increase in IV-related medication errors. Upon investigation of the issue, the administration learns that some errors occurred after licensed practical nurses administered IV medication, raising the question of whether administration of IV medications is within the scope of practice for LPN/LVNs.
Using the administrative nursing shared governance model, nurse supervisors and managers meet and review guidelines established by their state board of nursing. In this meeting, they determine whether it is appropriate to delegate IV medication administration to LPN/LVNs in their facility. After confirming which intravenous therapies may and may not be assigned to licensed practical/vocational nurses, representatives of the administrative council meet with chair members/representatives from each nursing department to discuss findings and measures to help reduce and/or eliminate the risk of errors moving forward.
If nursing management does not use shared governance in this situation, they may not discover the reason for errors or find appropriate measures to resolve the risk of future errors, which puts patient safety and outcomes at risk. If the problem results from improperly delegated assignments that remain unresolved, it could result in legal ramifications for the nurses and the hospital.
The Cardiac Intensive Care Unit nursing staff work twelve-hour shifts and rotate weekends off. Some nurses complain that it is difficult to attend continuing education seminars offered by the hospital. Still, they desire to earn continuing education credits and want to know what options are available.
By implementing a unit-based model of shared governance, nurses and nurse leaders can discuss what continuing education classes are best suited for the C-ICU nurses and determine if rotating class schedules to accommodate nurses who work nights or weekends is an option. The council may decide to offer several classes at different times to give each nurse an opportunity to attend without leaving patients unattended or teams short-staffed.
Whether it is right or wrong, many nurses feel it is the employer's responsibility to offer opportunities for continuing education, especially for those nurses who work odd shifts. Nurses who work nights sleep during the day and may not take the necessary time to find continuing education classes that fit into their schedules. A lack of shared governance to create educational opportunities in this situation could result in nurses not earning the necessary continuing education units required to maintain their nursing license.
Nursing management at Franklinton Medical Center is concerned about higher-than-normal turnover rates among registered nurses on staff.
Using the congressional model of shared governance in nursing, leaders work with staff nurses to find solutions to reduce turnover and promote long-term employee retention. Nurse leaders and representatives from each department’s council meet to discuss their thoughts about why turnover rates have increased and gather feedback and ideas on ways to improve the work environment and encourage employee retention.
Without input from nursing staff, nursing management can only assume they know why turnover rates have increased. They may consider and implement helpful changes. However, turnover rates could continue to rise unless concerns or problems are addressed.
Some healthcare facilities have wards or departments that require access codes or key cards to obtain entry. For example, South Haven Behavioral Health Hospital is a thirty-bed mental health inpatient facility. Nurses on staff have voiced concerns that the exit panel, which requires an access code, is positioned near the activity room, which is often filled with patients. Recently, one patient observed a nurse exiting the ward and found out the access code. He later entered the code and walked out of the facility.
Using a unit-based shared governance model, the council brainstormed and came up with suggestions for preventing a reoccurrence of this event. After meeting and discussing their ideas, the council chair met with facility administrators to ask for assistance in implementing measures to reduce the chances of the risk to patient safety from occurring again. Some suggestions include moving the exit panel to another location, requiring all staff to use a key card linked to them, or using fingerprint scans to facilitate opening doors.
Working in wards or departments which must remain locked may not feel like the ideal situation. However, behavioral health wards or inpatient facilities typically have designated areas where only employees and patients may enter for patient safety. A breach of this protocol could result in a patient being harmed or harming someone else. If staff had not utilized shared governance to find ways to reduce risks, another adverse safety event could occur. Adverse events can lead to risks to patient safety and could be grounds for legal action by a patient, family member, or anyone else affected.
Nursing homes are excellent places to implement shared governance. Shared governance councils in these facilities may include administrative staff, floor nurses, nursing assistants, and other employees. The following are two examples of shared governance in nursing home settings.
The nursing staff at Summer Plantation Nursing Home reports the patient lift used to transfer residents is worn and needs to be replaced. The staff has asked nursing management to consider replacing the lift with a newer model.
The nurses initiate shared governance actions by gathering valuable information such as the number of patients who require lift assist for transfers and comparing the cost of repairing the old lift versus the cost of a new lift. They also review reports of malfunction events associated with the current lift and the likelihood of a repair being a long-term or short-term resolution. After gathering information, the council presents their findings to leadership to consider and join in a joint decision about whether to purchase a new lift.
Nurses providing care to residents are better acquainted with the events related to the faulty lift. If there is a lack of shared governance, the administration may have fewer facts to base their decision on. In this case, the request for a new lift may be rejected, which may not occur if administrative staff had sufficient information and statistics related to patient care upon which they base their decision.
A common complaint among nursing home residents is they feel their personal preferences are overlooked or disregarded. For example, before moving into a nursing home, an individual may have a preferred time of day to go to bed or wake up in the morning. They may choose which foods to eat and what time to eat meals. Unfortunately, because nursing homes accommodate many residents and staff have designated responsibilities to accomplish each day, it may not be easy to do everything according to the resident's preference.
The nursing staff at Longleaf Nursing Home and Rehabilitation Center have asked the shared governance council to consider options to help residents have more control over their schedules without disrupting the flow of work and patient care.
In the spirit of shared governance, the council reviews and discusses ideas submitted by nursing staff and residents about ways they feel the resident's preferences can be honored. Council members agree that ambulatory residents who can serve themselves may benefit from choosing what time they go to bed or get up each day. They also feel the suggestion of offering alternate snacks or substituted meals is appropriate, within reason, if the meals and snacks are compliant with the patient's dietary plan of care. The council decides which measures could be easily implemented and presents those ideas to the administration for final approval.
Having a set schedule for retiring in the evening or waking in the morning is convenient for nursing home staff who care for several patients each day. In this situation, a lack of shared governance would make it easy for nurses to overlook the client's preferences. However, the long-term result of client dissatisfaction could result in poor client retention and lower satisfaction rates, which affect healthcare costs.
Nurse educators use shared governance in various ways while promoting nursing education. One of the first places would-be nurses learn about shared governance in nursing school. A few examples of using a nursing shared governance model in nursing education are the following.
Constant changes in healthcare create a demand for nurse educators to be aware of updates relevant to patient care. It is the responsibility of nursing faculty to ensure they present students with current information and resources. One way they accomplish this is to review textbooks and determine the ones that offer the most current data to promote student success.
Ms. Stennett is the Director of Nursing at Monroeville Community College. At the end of the spring semester, Ms. Stennett feels it is time to review current textbooks and compare them to alternative newer editions and alternative textbooks.
Ms. Stennett schedules a staff meeting with all nurse educators to discuss the current curriculum and textbooks and review options for new textbooks. She asks each instructor to bring ideas related to the courses they teach, including how to increase student engagement and their thoughts about what the current curriculum and textbooks offer and how new materials and books can benefit students and the school.
Instructors may prefer the layout of one textbook over another or feel their choice of a textbook is more aligned with their teaching method. While the Director of Nurses is well within her right to choose textbooks she feels appropriate for her program, a lack of shared governance could leave instructors feeling as if their opinions are not valued.
Mr. Broussard is the clinical coordinator for the university nursing department. Although students in the program have learned about the concept of shared governance in the classroom, Mr. Broussard feels it is appropriate for the students to learn how to demonstrate it.
To help students grasp what it means to participate in shared governance, he creates student councils for each level of the program. He asks students to collaborate and create clinical rotation schedules for students at every level of clinicals. The students have one week to work together, share ideas, and create mock schedules, at which time the chairs and co-chairs will present their recommendations to Mr. Broussard.
As they implement this exercise of shared governance in nursing, students must consider several variables and determine the best course of action to provide safe, effective patient care. To meet the guidelines for clinical rotation assignments, students must consider what level each clinical group has achieved in the program and which settings and assignments are appropriate. Additionally, they must ensure the student to instructor ratio is within guidelines.
If the nursing students in this example choose to act independently instead of within a shared governance model, the chances of poor implementation rise. The likelihood of inappropriate assignments increases. While this is a classroom assignment that will not negatively impact patient care, if they do not learn how to use shared governance to their advantage, this behavior could carry over into their professional roles later.
Joining nursing organizations or associations is an excellent way for nurses to broaden their professional network and stay engaged with up-and-coming trends in nursing. Here is an example of how nursing organizations may utilize shared governance in nursing.
The chair and co-chairs of ABC Nursing Organization will begin accepting new applications for membership after their summer session. They feel it is appropriate to review criteria for membership and suggest the council make recommendations for updated criteria before application reviews begin.
Nursing organizations typically have members from diverse backgrounds and professional levels. Using shared governance, the council members can express their ideas regarding membership stipulations. For example, issues such as holding an active, unencumbered license to practice, years of experience, or professional specialty are almost always relevant. The council may feel that participation in volunteer opportunities or community outreach should be criteria. The team can collaborate about how the organization may be best represented and work together to establish guidelines for published criteria.
Lack of shared governance in this scenario could result in the opinions of only a couple of people determining the final decision. This could cause frustration later if organization members feel admission criteria are too lax or too strict.
Adopting shared governance in nursing can benefit patients, nurses, interdisciplinary teams, and healthcare organizations. There are several approaches to shared governance. There are also challenges to the effective use of shared governance. The following are four of the most common challenges nurses may face and suggestions on how to overcome them.
Teamwork is essential for shared governance in nursing to be effective. When teamwork is lacking, nurses on shared governance committees or councils are more likely to disagree with one another, making it difficult to make critical decisions. It can also lead to a decline in the quality of patient care, poor team morale, poor patient outcomes, and higher employee turnover.
Nurse leaders can be instrumental in strengthening teamwork efforts. A few steps to improve teamwork include clarifying the roles and responsibilities of each team member, handling conflicts as soon as they arise, encouraging others in their endeavors to provide high-quality care, and acknowledging the strengths and contributions of each team member.
Poor communication can impact every aspect of a person's life, whether personal or professional. It is one of the biggest challenges of nursing shared governance. Poor communication may result from a lack of understanding or fear of rejection. It can also occur when someone feels that their opinions are not important.
It is possible to overcome poor communication. Nurse leaders should set an example for respectful, effective communication for nurses to follow. Nurses should encourage one another to express their thoughts, feelings, and ideas without fear of judgment. It is also necessary to become self-aware.
For example, take note of your body language and tone of voice. If you speak in a sharp tone, your body language is rigid, or you appear uninterested, your team members will feel you are unapproachable. Speak in a calm tone, act interested in what your team members say, ask questions, and encourage your team members.
Every nurse has an individual role and responsibilities. While nursing shared governance is an excellent concept with proven benefits, if nurses don't understand their independent roles, they may become confused about their roles within the shared decision-making process shared governance offers.
Nurses should clarify their roles and responsibilities. After determining one's independent role, it becomes easier to understand their role within the shared governance model. Nurse managers and team leaders can help alleviate this challenge by giving clear instructions about expectations for the nurse's role and establishing guidelines for implementing shared governance.
Although shared governance in nursing puts authority, accountability, and responsibility for practice-related decisions into the hands of nursing teams, administrators remain accountable for the actions of their staff. Because they remain responsible for staff actions, some administrators prefer to rely on upper management to make crucial decisions with little or no input from staff.
The most effective way to overcome this challenge is to educate nursing administrators about the benefits of shared governance in nursing. For example, when implemented correctly, nursing shared governance leads to improved patient outcomes, lower safety risks, higher patient satisfaction rates, better employee morale, and increased staff retention.
One way to increase the use and effectiveness of shared governance in nursing is to learn as much as possible about the concept. The following are examples of some resources, including blogs, YouTube videos, and podcasts offering information about shared governance.
• The Association for Nursing Professional Development is dedicated to advancing the specialty practice of nursing professional development. The Association's mission is to enhance healthcare outcomes for patients and nurses. Here is one of the Association's articles on shared governance, "Shared Governance- What It Is and Is Not.”
• Anne Arundel Medical Center’s Together Nursing Blog was developed as a way for nurses and staff at AAMC to connect with one another, patients, visitors, and the community. The blog features several articles relevant to nursing care and improving patient outcomes, including this featured article, "Does Shared Governance Work?”
• Empowering Nurses Through Shared Governance: In this thirty-minute YouTube information video, learn how St. Jude’s nursing leadership implemented a revised shared governance structure to empower staff nurses in practice.
• What Is Shared Governance?: Nurses from the University of Chicago Medicine explain what shared governance in nursing means to them. They describe how shared governance provides nurses with a voice and opportunities to advance and improve patient care.
• How Shared Governance and Actionable Data Can Empower Nurses: This podcast featured by the American Hospital Association is hosted by Michelle Davis, assistant vice president of medical services at Unity Health, Searcy, Arkansas. Ms. Davis discusses how shared governance promotes collaboration and partnerships between nurses and other healthcare providers. (Sponsored by Spacelabs Healthcare)
• Sustaining Shared Governance: This is an eight-minute podcast from Nursing Management featuring Editorial Board member and shared governance in nursing pioneer Tim Porter-O'Grady about the essential principles needed to sustain shared governance.
Communication between bedside nurses and nurse leaders is essential for successfully implementing a successful, shared governance nursing model. Clear and consistent communication promotes collegiality, trust, and patient safety.
Communication and collaboration among nurses are essential to effective patient care and solid shared governance in nursing. Nurses must also collaborate with other healthcare professionals and interdisciplinary team members. Collaboration brings all members of the care team together to make positive, meaningful changes to projects, policies, and procedures which impact patient and organizational outcomes.
Strong problem-solving skills are essential for every nurse. They are especially important in nursing shared governance, as nurses and other healthcare professionals collaborate on important patient care issues and organizational policies and procedures.
Critical thinking skills are essential for nurses as they help them make patient-care decisions based on the best available information. Information used for critical thinking skills is gleaned from past experiences and knowledge of the healthcare and nursing fields. When nursing teams work together in shared governance, and each nurse utilizes critical thinking skills, it helps promote a more positive practice environment.
All nursing shared governance models involve decision-making. Nurses involved in shared governance should have solid decision-making skills and a willingness to voice their thoughts on why certain decisions are appropriate.
Autonomy in nursing refers to the nurse's power and authority to determine essential components of a patient's care without consulting with physicians to decide. Although shared governance in nursing focuses on a team effort, the nurse’s ability to demonstrate autonomy helps strengthen the team, especially if each member recognizes and utilizes this skill.
Some people suggest that accountability is more of a characteristic than a skill. However, as a nurse educator, I believe it takes true nursing skill to understand the act of being accountable and demonstrate it in practice. Accountability is associated with confidentiality, dependability, and advocacy, which nurses need to develop strong nurse-patient and interdisciplinary relationships.
In this article, we addressed the question, “What is shared governance in nursing?” and shared
10 benefits of shared governance in nursing + 10 examples of how to implement it. Whether you are a new nurse or a nurse with many years' experience, shared governance can benefit your practice, your patients, and the organizations you represent.
Shared governance in nursing is relevant and essential in developing strong nursing and interdisciplinary teams and providing safe, high-quality patient cares, which helps improve patient outcomes.
While not required, most healthcare organizations implement some type of shared governance model. It is significant for hospitals that wish to obtain Magnet status, as a proven system of shared governance in nursing is one of the criteria for earning Magnet status.
Tim Porter-O'Grady is credited with developing the concept of shared governance in nursing.
Nursing shared governance structure refers to how shared decision-making is implemented in practice. It involves putting the authority, accountability, and responsibility for decision-making in nursing into the hands of those who will implement measures to perform and act upon those decisions.
Nursing shared governance model refers to how shared governance is structured and who is involved. For example, unit-based shared governance models are tailored to a specific nursing unit where nurses and nurse leaders work to make decisions related to the delivery of nursing care. The administrative model includes executive-level members who oversee the work and decisions made by smaller councils.
Nursing shared governance council refers to the group of people elected or appointed to manage affairs relevant to their group or organization. For instance, nursing shared governance hospital councils include nurses from each hospital unit who come together to discuss issues affecting patient care and nursing practices throughout the entire hospital. Themed councils in shared governance address broader issues, including professional development or safety and quality.
Nurses can request opportunities to participate in a shared governance model. The decision of which model is used, who is involved, and how many members are involved is usually established by the organization.
Although some nurses may choose to not actively participate in a nursing shared governance model, all types of nurses can participate in shared governance.
The ratio of bedside nurses to nurse managers in a shared governance model varies depending on which model is used and how many staff are represented. Most sources indicate a ratio of ten bedside nurses to one nurse manager is the norm in a shared governance model.
Being part of a shared governance model of nursing can benefit a nurse's career. Shared governance empowers nurses to utilize their expertise and clinical knowledge to direct and maintain their own professional practices. It also promotes engagement as an integral part of the interdisciplinary team's collaborative efforts.
Participating in shared governance in nursing offers nurses the opportunity to voice their opinions, share ideas, and be involved in vital decisions regarding patient care and organizational issues. Nurses benefit by learning and strengthening team-building, critical thinking, decision-making, and interpersonal communication skills.
Shared governance is beneficial to nurse managers as it allows them to have insight into the thoughts, feelings, and ideas of staff nurses. Nurse managers also benefit because they can strengthen their leadership skills by utilizing the collaborative efforts of the nursing and interdisciplinary teams to promote better patient outcomes, support employee retention, and reduce healthcare costs.
Some bedside nurses feel participation in a shared governance model is too much work. Many nurses work long shifts or nights and weekends or have responsibilities and obligations outside of work that demand their time and attention, which makes being an active member in a shared governance model challenging.
Nurses can decline opportunities to actively participate in shared governance models. It's important to understand that a nurse's lack of participation in shared governance does not mean the concept will not be used.
Shared governance is a concept that can be implemented in any setting where decisions must be made. Regarding healthcare and nursing decisions, a person does not have to be employed within a nursing role to participate in shared governance. Shared governance models include staff nurses, other medical professionals, and administrative personnel, as necessary to reach each model's goals and expected outcomes.
While shared governance and participatory management may have the same goals, there are distinct differences. In shared governance, staff are given the authority, responsibility, and accountability to determine goals, obtain input from colleagues, and make autonomous decisions within guidelines established by leaders. Participatory management, on the other hand, involves leaders requesting input from staff to determine goals. However, the use of staff input is optional. In participatory management, staff may make suggestions about handling a situation, but the final decision lies with the leader who may reject any input from the staff.
The leadership style required to properly implement nursing shared governance is servant leadership. Servant leadership requires leaders to allow their team members to voice their opinions and ideas and accept accountability and credit for the results.
The concept of shared governance in nursing remains the same, regardless of which other professionals are involved. However, it is crucial for nurses to understand and appreciate the input from non-nursing professionals involved and to consider their contributions in decision-making.
When shared governance is implemented, it can result in more cost-effective care for patients. First, the financial implications for registered nurse job turnover range from $38,000 to $59,000 per RN. That cost is, naturally, passed onto patients. Shared governance in nursing has been proven to reduce nurse turnover, which means there are less financial implications. Additionally, research shows that shared governance is associated with fewer errors and omissions and better patient outcomes, which also help reduce the cost of healthcare.
Shared governance in nursing involves obtaining information from each team member, including sharing of information such as patient data, when appropriate. Therefore, shared governance is effective for data collection in nursing.
Darby Faubion BSN, RN
Darby Faubion is a nurse and Allied Health educator with over twenty years of experience. She has assisted in developing curriculum for nursing programs and has instructed students at both community college and university levels. Because of her love of nursing education, Darby became a test-taking strategist and NCLEX prep coach and assists nursing graduates across the United States who are preparing to take the National Council Licensure Examination (NCLEX).
