In the 1980s, the shared-governance leadership model was popularized so registered nurses (RNs) could take control of decision-making in clinical settings. Nearly 40 years later, shared governance has become a mainstay of Magnet hospitals and medical centers nationwide.
Shared governance in nursing allows RNs to meet goals outlined in the Institute of Medicine’s landmark report, The Future of Nursing: Leading Change, Advancing Health. The report advocates for nurses to practice to the full extent of their education and to participate in nonhierarchical decision making. Shared governance increases nurse engagement, improves patient outcomes and allows hospital administrators to optimize efficiency, increase nurse retention and promote quality care, a study in The Journal of Nursing Administration found.
“Improving nurse engagement in [shared governance] may serve as a transformational leadership strategy to improve the patient experience—an outcome directly tied to reimbursement. Of additional financial interest to hospital administrators, greater involvement of nurses in [shared governance] is also associated with outcomes related to nurse retention and nurse-reported quality and safety of patient care. These findings are useful in informing evidence-based, organizational-level interventions aimed at improving patient outcomes by promoting nurse engagement,” the journal’s study, Nurse Engagement in Shared Governance and Patient and Nurse Outcomes, found.
Nurse leaders, including DNP-educated RNs, understand that one component of being an effective nurse manager is improving nurse engagement. Shared governance improves engagement by promoting ownership, accountability and equity. The result is improved healthcare outcomes.
Shared Governance in Nursing
Shared governance in nursing was popularized in 1985 with the publication of Shared Governance for Nursing: A Creative Approach to Professional Accountability. One of the authors, Tim Porter-O’Grady, defined shared governance as a “structural model through which nurses can express and manage their practice with a higher level of professional autonomy.”
When the American Nurses Credentialing Center (ANCC) developed its Magnet Recognition Program for hospitals and medical centers, it included shared governance as a provision for excellence. Facilities can design their shared governance framework for a personalized experience. Rhonda Collins, DNP, RN, chief nursing officer (CNO) at the healthcare communications company Vocera, said shared governance models are numerous and diverse.
Collins, in Magnet Hospitals and Shared Governance: Empowering Frontline Nurses, said front-line nurses benefit from shared governance because it allows them to thrive.
“Shared governance is focused on empowering the people who work every day making life better for patients and families,” Collins said.
Collins stated that when she worked as a CNO at a Magnet hospital, committees were established across the various nursing disciplines – ICU, labor and delivery, NICU, medical/surgical and others. The committees, made up of nurses who worked in the units, met monthly to discuss issues of importance, including policy and practice. A house-wide practice council, made up of one representative from each committee, made decisions and recommendations that would impact the entire nursing body.
Collins said shared governance models are only successful when nurses and management support the core values.
Developing Core Values in Shared Governance
In fact, Gen Guanci, RN and Creative HealthCare Management consultant, said shared governance could not be successful without the backing of nurse managers. Guanci, in Nurse Manager’s Role in Shared Governance and Unit Councils, said nurse managers support shared governance in several ways:
- Acting as a developmental facilitator
- Helping committees function smoothly without taking charge
- Helping committee members see all sides of an issue
- Coaching committee members on the process and role
- Addressing questions without attending meetings
- Serving as a guide and catalyst for action
- Fostering creativity, productivity and ownership
At the same time, Marky Medeiros, MSN, RN, said sound principles must be used when developing shared governance. Medeiros, in Shared Governance Councils: 10 Essential Actions for Nurse Leaders, said shared governance requires specific efforts from nurse leaders:
Clearly explain shared governance and its importance
Clinical staff members should understand that shared governance is a venue for change and improvements. Shared governance puts problem-solving in the hands of those positioned to make changes and provide better care. RNs implementing shared governance should understand that it is not intended to add additional work. Instead, it refocuses efforts at points of need. It allows staff nurses to provide focus and direction for optimal health outcomes.
Create a structure of shared governance
The shared governance model usually includes a council, committee or task force that identifies and promotes best practices in nursing. The structure should include chairs and co-chairs and follow rules of order for meetings, agendas and minutes.
Make shared governance accessible
A shared governance committee or council should include a diverse group of staff members with varied opinions. Meetings should be held on a schedule that allows for in-person, phone or video conference attendance and should be accessible to all.
Provide ongoing support for meeting planning, data analysis and skills development to foster success. Recognize team members for their accomplishments and share positive results with other committees to highlight accomplishments.
“Nurse leaders are instrumental in council success by providing needed support and skills, and empowering teams to make decisions that lead to improvements in patient care, clinical outcomes, and staff satisfaction,” Medeiros stated.
Indeed, the shared-governance model has been used successfully across the United States. Nurse leaders are at the forefront of implementing the model for nurse satisfaction and retention.
Nurse Leaders Prioritizing Shared Governance
When nursing leaders at Houston Methodist Hospital in Texas used the shared-governance structure to improve nurse turnover rates, they saw success, a study titled Bedside Clinicians Retain Nurses Through Turnover Analysis and Best practices stated.
“Nurses value a positive work environment, autonomy, leadership support, and opportunities that promote professional growth and job satisfaction,” study authors said. “Shared governance offers a vehicle to engage nurses and fosters team collaboration as peers challenge each other to achieve a common goal. Reinforcement comes when leaders recognize and reward employees who add value to the organization.”
Shared governance recognizes that being an effective nurse manager depends on mutual respect and a healthy exchange of ideas, among other things. At Duquesne University, DNP candidates develop leadership skills that focus on problem solving, teamwork and improved healthcare outcomes.
About Duquesne University’s Online DNP Program
Since 1935, Duquesne University has been educating nurses to take leading roles in healthcare. Administrators, professors and staff work to ensure that RNs receive the best DNP education and learn evidence-based skills and practices to improve health outcomes.
The coursework is 100% online, allowing RNs to work toward an advanced degree while maintaining career and family responsibilities. For more information, visit the university’s online DNP program website.
Nurse Engagement in Shared Governance and Patient and Nurse Outcomes: The Journal of Nursing Administration
Shared Governance: What it Is and Is Not: Association for Nursing Professional Development
Magnet Hospitals and Shared Governance: Empowering Frontline Nurses: Vocera
Nurse Manager’s Role in Shared Governance and Unit Councils: Truth Point
Shared governance councils: 10 essential actions for nurse leaders: Nursing Management