Shared Governance in Nursing: Who rules?

1. SHARED GOVERNANCE in
Nursing: Who rules?
Emmanuel C. Lapidez, RN, MAN
Reviewed by: Dr. David Hali De Jesus

2. GOVERNANCE
According to Hess (2004), Governance is about…
GOVERNANCE
POWER CONTROL
AUTHORITY INFLUENCE

3. SHARED GOVERNANCE
It is an organizational strategy through which nurses can express
and manage their practice with a higher level of professional
autonomy (Porter, 2003)
It is an effective strategy for
enhancing autonomy and providing
avenues for nurses to gain control
over their practice. (Green, 2004)

4. SHARED GOVERNANCE
Professional nurses have a long
history of struggling to deliver patient
care against multiple barriers and
their role as patient advocates often
places them in direct conflict with
administrators of health care
organizations (Green, 2004).

5. SHARED GOVERNANCE
One organizational strategy that has long
been stressed as a mechanism by which
nurses can advocate for and manage their
professional role is that of shared
governance (Porter, 2003).
In order to give these clinical nurses equal
footing with managers to allow them to
participate in the decision-making
processes that affect their practice (Hess,
2004).

6. SHARED GOVERNANCE:
Shared Governance strategies focus on creating a partnership between the
organization and the individual nurse in order to create an organizational
environment where individual professional accountability is respected and
encouraged. (Green, 2004)
Who Shared?

7. SHARED GOVERNANCE:
In a shared governance organization
decision making is more decentralize
and takes place through a designated
committee or council structure, but
both staff and managers have
responsibilities and accountability
(Finkelman, 2012).
Who Govern?

8. Shared governance is a management model,
but it emphasizes the need for nurses to share
accountability and responsibility. Nurses have
the authority to make sure the right decisions
are made about the work that they do
(Finkelman, 2012).
SHARED GOVERNANCE: Who Govern?
In shared governance, as in
nursing, the primary
resources for practice are
the providers themselves.
Thus, to control practice,
nurses must have influence
over themselves as a
professional group (Hess
2004).

9. SHARED GOVERNANCE:
SG is an organizational strategy that employs the attributes of partnership, equity,
accountability, and ownership between the worker and the workplace (Green, 2004).
Who Benefit?
Therefore, employees, patients, the
organization, and the surrounding
communities benefit from shared
governance (Swihart, 2006).

10. BRIEF BACKGROUND ON EMERGENCE OF SG
CONTRIBUTING FACTORS TOWARDS SHARED GOVERNANCE
ACCOUNTABILITY
EMPOWERMENT
It provides a structural format within an organization through
which nurses can express and manage their practice with a higher
level of professional autonomy, resulting in greater accountability
within an organization (Porter-O’Grady, 2003).
It focuses on strengthening nursing’s voice and ensuring nurses’
involvement in workplace decisions that affect patient care.
Whether operating at the micro or macro level, empowered
nurses can improve the environment and enhance delivery of
quality health care (Green, 2004)

11. BRIEF BACKGROUND ON EMERGENCE OF SG
CONTRIBUTING FACTORS TOWARDS SHARED GOVERNANCE
CONFLICT RESOLUTION
PATIENT ADVOCACY
It provides specific channels of communication for conflict
resolution within individual organizational settings and
adequately prepare nurses to effectively deal with conflicts
arising around patient care and physician-related issues
(Green, 2004).
SG provides a structural mechanism within organizations
whereby nurses speak up to improve practices, and thus
promote the safest and best possible outcomes for patients
(Green, 2004).

12. BRIEF BACKGROUND ON EMERGENCE OF SG
ACTION TOWARDS SHARED GOVERNANCE (HESS, 2004)
Shared governance is a journey, not a destination.
Organizations that implement shared governance are in a constant process of
revitalization and renewal.
Not every environment is conducive to shared governance.
The leadership group needs to be willing and able to shift roles and power. For
specific areas in which staff nurses need to be adept and predisposed to share
authority.

13. BRIEF BACKGROUND ON EMERGENCE OF SG
ACTION TOWARDS SHARED GOVERNANCE (HESS, 2004)
The journey can be long and steep.
It can be a consciousness-raising event that allows organizational members to
thrive. Maintenance will be necessary to keep everyone's expertise current.
Even those who are not directly involved in the model need to be educated and
informed, because shared governance affects everyone.
Although not everyone might make the journey, it should be open to all
For practitioners to have control over practice they need the participation of
others in the organization who provide support.

14. BRIEF BACKGROUND ON EMERGENCE OF SG
ACTION TOWARDS SHARED GOVERNANCE
Is the journey worth the price?
Researchers have studied nursing shared governance for its relationship to
professional collaboration and collegiality; retention; autonomy and
empowerment; morale and both nurse and patient satisfaction; values and
organizational culture; quality and patient outcomes; and versatility,
competency, and productivity. Unfortunately, many of the relationships
reported are inconsistent and flawed.

15. BRIEF BACKGROUND ON EMERGENCE OF SG
GROWING NEEDS IN SHARED GOVERNANCE FOR COLLABORATION, ENGAGEMENT
IN HEALTH CARE PRACTICES
Demonstrates ability to engage in
decision making about patient
management issues.
Demonstrates ability to engage
in the development of standards
of practice.

16. BRIEF BACKGROUND ON EMERGENCE OF SG
GROWING NEEDS IN SHARED GOVERNANCE FOR COLLABORATION, ENGAGEMENT
IN HEALTH CARE PRACTICES (REEVES, 1991)
Demonstrates ability to
engage in quality assurance
(QA) monitoring.
Demonstrates expert conflict
resolution skills.

17. BRIEF BACKGROUND ON EMERGENCE OF SG
GROWING NEEDS IN SHARED GOVERNANCE FOR COLLABORATION, ENGAGEMENT
IN HEALTH CARE PRACTICES
Demonstrates expert negotiation skills.

18. GOVERNANCE MODELS
THE WHOLE SYSTEMS GOVERNANCE
As the nurse executive expands the role and assumes increasing responsibility
for creating new frameworks for care, a structure that sustains the point-of-care
innovations and interdisciplinary relationships must be built. Whole systems
models of organization, such as shared governance, are expanding as demand
grows for a sustainable structure for horizontal and partnered systems of
healthcare delivery. The executive will have to apply these newer frameworks to
the delivery of care to provide adequate support for the clinically integrated
environment (Evan, 1995)

19. GOVERNANCE MODELS
NURSE– SHARED GOVERNANCE
THE NURSING PRACTICE MODEL of shared governance is a key strategy
for enhancing work environments in Magnet hospitals (Batson, 2004).
These latter models include those identified
as shared governance models. Conceptually,
governance models are appealing because
they are designed to integrate core values
and beliefs that professional practice
embraces as a means to achieve quality care
(Anthony, 2004).

20. GOVERNANCE MODELS
PROFESSIONAL – SHARED GOVERNANCE
Professional governance is the structure that allows the thoughts,
perspectives, expertise, and influence of clinical nurses to be at the table
regarding decisions around nursing practice and the practice environment
(Fuentes, 2019).
For professional governance to
be fully functional, a structural
foundation is required to allow
and encourage ideas and work
to flow without unnecessary
barriers (Fuentes, 2019).

21. PROFESSIONAL – SHARED GOVERNANCE MODEL
According to Porter O’Grady, Hawkins, and Parker (1997), when an
organization embraces professional governance concepts, the culture
shifts toward work that supports the following principles:
1. Partnership – Partnership is essential to building relationships, involves
all staff members in decisions and processes, implies that each member
has a key role in fulfilling the mission and purpose of the organization,
and is critical to the healthcare system’s effectiveness (Swihart, 2006).
2. Ownership - recognition and acceptance of the importance of
everyone’s work and of the fact that an organization’s success is bound to
how well individual staff members perform their jobs (Swihart, 2006).

22. PROFESSIONAL – SHARED GOVERNANCE MODEL
4. Accountability - a willingness to invest in decision-making and express
owner- ship in those decisions. Accountability is the core of shared
governance. It is often used interchangeably with responsibility and
allows for evaluation of role performance (Swihart, 2006).
3. Equity - the best method for integrating staff roles and relationships
into structures and processes to achieve positive patient outcomes.
Equity maintains a focus on services, patients, and staff; is the
foundation and measure of value; and says that no one role is more
important than any other (Swihart, 2006).

23. APPRECIATE SHARED GOVERNANCE
Advantages of Shared Governance
(Swihart, 2014 and Porontaus, 2009)
Improved patient care outcomes and shorter lengths of stay. Thus, better safety
and healthcare
Better financial states due to cost savings and cost reductions
Increased nurse satisfaction with shared decision-making related to increased
responsibility combined with appropriate authority and accountability
Increased professional autonomy with higher staff and nurse manager retention

24. APPRECIATE SHARED GOVERNANCE
It provides empowerment for members of organization and has greater
patient and staff satisfaction. Thus, longevity of employment.
Shared leadership makes collaboration better and relies heavily on good
communication; it emphasizes process and participations.
The leadership structure ensures program and service quality/consistency in
harmony. It incorporates planning, review, and adjustments which allows
revisiting mission, vision, and values.
Shared leadership balances ammount of work, builds in cross-training and
redundancy to reduce the impact of personnel changes, takes advantage of
people's unique skills and expertise.

25. APPRECIATE SHARED GOVERNANCE
Disadvantages of Shared Governance
(Porontaus, 2009)
It slows decision-making because there are more individuals involved than
the traditional hierarchy
It slows implementation because it takes more time to communicate and
achieve consensus, and to plan and assess when there are more participants.
Strategic initiatives such as implementing new programs and services can
suffer because administrators are busy elsewhere.
It is not easy to develop, It takes time to be effective, and it can become a
barrier to delivery of efficient, high quality care. (Finkelman, 2012)

26. IMPLEMENTATION OF SHARED GOVERNANCE
10 essential actions for nurse leaders to put Shared Governance into practice.
1. Be clear about what shared governance is.
2. Help staff members understand why shared governance is important
3. Orient council chairpersons on the basics of planning and running meetings
4. Cultivate a sense of ownership
5. Encourage a continuous focus on mission and vision

27. 6. Provide council members with protected time to meet
7. Include staff in council development or redesign
8. Coach and mentor chairpersons
9. Recognize excellence
10. Study the successes (and struggles) of others
IMPLEMENTATION OF SHARED GOVERNANCE

28. References:
Green, Alexia, and Clair Jordan. "Common denominators: shared governance and work place advocacy: strategies for nurses to gain
control over their practice." Online Journal of Issues in Nursing 9.1 (2004): 171-178.
Porter-O’Grady, T. (2003b). Researching shared governance: a futility of focus. Journal of Nursing Administration, 33(4), 251-252.
Hess, R., (January 31, 2004). "From Bedside to Boardroom – Nursing Shared Governance". Online Journal of Issues in Nursing. Vol. 9
No.1, Manuscript 1.
Fuentes, G., Holm, R., Browder, B., Macy, D., & Middlemiss, J. (2019). Rethinking Your Unit Council Structure. Sigma.
Porter-O’Grady, T., Hawkins, M. A., & Parker, M. L. (Eds.). (1997). Whole-systems shared governance: Architecture for integration.
Gaithersburg, MD: Aspen Publishers.
Reeves, S. (1991). Professional governance: assessing readiness of an organization for change. Master’s thesis. University of New
Hampshire; Durham, NH.

29. References:
Swihart, D. (2006). Shared governance: A practical approach to reshaping professional nursing practice. HCPro.
Evan, K., Aubry, K., Hawkins, M., Curley, T. A., & Porter-O'Grady, T. (1995). Whole systems shared governance: a
model for the integrated health system. The Journal of nursing administration, 25(5), 18-27.
Batson, V. (2004). Shared governance in an integrated health care network. AORN journal, 80(3), 493-514.
Anthony, M. K. (2004). Shared governance models: the theory, practice, and evidence. Online J Issues Nurs, 9(1), 7.
Purontaus, V. (2009). The Pro’s and Con’s of Shared Leadership
Porter-O’Grady, T. (2003b). Researching shared governance: a futility of focus. Journal of Nursing Administration,
33(4), 251-252.

30. Slides are uploaded for information
purposes and as partial requirement
of Philippine Women's University in
PhD class; Subject:Governance in
Health Care Practice.