These slides is uploaded for information purposes and as partial requirement of Philippine Women's University in PhD class; Subject:Governance in Health Care Practice

1. A Traverse on the Horizon
by Kenneth Natuan Catapang RN, MAN
Shared Governance in
Nursing:

2. Concepts of Shared Governance
in Nursing
“A professional practice model, founded on the cornerstone
principles of partnership, equity, accountability, and
ownership that form a culturally sensitive and empowering
framework, enabling sustainable and accountability-based
decisions to support an interdisciplinary design for excellent
patient care.” - Dr. Tim Porter-O'Grady.
• The idea of shared governance or decision-making, is a
longstanding one. Different fields like education, business and
management, and healthcare have all benefited from different
shared governance process models instigated in many diverse
and creative ways across generations and cultures.
• Shared governance is based on the proposition that staff
should have access to information, resources, and growth
opportunities by being involved in the decisions that affect
their practice.

3. Concepts of Shared
Governance in Nursing
• Shared governance stimulates a sense of
empowerment along with responsibility and
accountability for nurses.
• It consents active involvement in the decision-
making process, predominantly in managerial areas
from which staff nurses were previously excluded.
• Participation in decision-making permits staff to
develop and apply the best practices for workflow
and improved outcomes.
• The role of nurse managers in a shared
governance environment is to assist as experts for
regulatory requirements and safeguard that RN
teams' initiatives stay within policy and guidelines.

4. • Underpinning framework of shared governance is grounded on collaboration and
communication at all levels, across all service lines.
• Consider of it as a shared leadership. This transformation of culture and practice
further empowers multidisciplinary teamwork to optimistically influence quality of
care and foster excellent outcomes.
• This conveys the impression of shared governance as not just a nursing practice
model, but as well as an organizational practice model into focus.

5. Who shared?
o Shared governance is shared by nurses to collaborate with
others and use a range of input to generate new methods for
organization and work safety, as well as to preserve a fitting
work experience for all.
o It encourages staff nurses and administrative leaders to
collaborate to establish internal policies governing the clinical
practice and delivery of quality care.
o Members must be adaptable and prepared to work not for
themselves but for the interest of the staff as a whole. These
staff nurses must be appreciated and must not feel that the
committee is taking them away from their daily duties.
However, they should be keen to make arrangements if
needed and be flexible to any changes that the committee
perceives suitable to employ.

6. Who governs?
"Shared" means that everybody has a function or responsibility.
o Decision-making must be shared at grassroots level which
means that the management structure must be decentralized.
To make that transpire, employee partnership, accountability,
and ownership must occur at the point of service.
o At least 90% of the decisions need to be created there.
Indeed, in matters of practice, quality, and competence, the
locus of control in the professional practice environment
must shift to practitioners. Only 10% of the unit-level
decisions should go to management.
o Systems of shared governance may change from one facility
to another due to unique organizational values and goals. It
helps to stimulate professional practice environments while
enabling nurses to support decisions affecting their selves,
colleagues, and patients.

7. Who benefits?
• Shared governance benefits all members of the healthcare
workforce to have a voice in decision-making, thus uplifting
diverse and innovative input that aid to advance a healthcare
organization. It makes every staff feels like he or she is
“part manager” with a personal stake in the success of the
organization.
• Staff nurses then positively influence their work setting
through active participation in the decisions that affect
practice. This empowerment can lead to higher retention
rate.
• Eventually, those who are satisfied in their jobs take greater
ownership of their decisions and are more vested in patient
outcomes. Therefore, employees, patients, the organization,
and the surrounding communities benefit from shared
governance.

8. Brief History
1960s
• Idea that employees at the point of care are the single most valuable organizational
asset. Thus, practices such as autonomy, empowerment, involvement, and
participation in decision making were advocated.
Mid-1960s
• The earliest foundation for shared governance arose from the human resource era of
organizational theories. This era represented the first departure from the traditions of
scientific management.
19XX
• Shared governance found its way into the business and management literature.
Organizations began to design structures and relationships among their leaders and
employees. They emphasized making decisions from the point of service on instead
of from the organization downward.

9. Late 1970s &
early 1980s
• Shared governance formally found its way into the healthcare and nursing arenas, growing out
of nurses’ dissatisfaction with the institutions in which they practiced. They started to use it
as a form of participative management, using self-managed work teams.
Late 1980s
• The value system of autonomy, involvement, and empowerment was at the forefront of
practice and advocated for as not only a means to drive care, but also to recruit and retain
engaged employees.
1985 & early
1990s
• Shared governance in nursing was popularized 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.”

10. Early 2000’s
• American Nurses Credentialing Center (ANCC) developed its
Magnet Recognition Program for hospitals and medical centers, it
included shared governance as a provision for excellence.
At present
• Nurses now seek employment in facilities because they have
shared governance models; it has become not only an expectation
but the accepted norm for professional nursing practice.

11. • "Shared" governance has derived to signify two corresponding and sometimes overlapping
concepts:
1. Providing various groups of people a share in key decision-making processes, often
through elected representation
2. Allowing certain groups to use key responsibility for specific areas of decision
making.
• The principle of shared governance goes down in the use of councils and committees.
These groups should be represented by motivated and capable staff nurses whose main
interest lies in the greater good. Together, they work towards a common goal and will do
everything they can to ensure they reach it.
Contributing Factors

12. Contributing Factors
• Applying and supporting shared governance is a demanding task. To do so, calls for
a real correspondence between management behavior and the structural
imperatives of a shared decision-making model is much needed.
• Synthesis between the staff’s competence in making their own decisions about
practice, and their profession and the leader’s ability to facilitate them should be
present.
• Leadership must be able to promote a safe and developmental context for both
staff and themselves so that the challenges associated with a substantial change in
the old-fashioned locus-of-control can be carefully tackled, and professional
practice can justly progress.

13. Principles of Shared Governance
Equity
•It signifies that each team member is essential to providing safe and effective care. It maintains an
emphasis on services, patients, and staff; is the foundation and measure of value; and indicates that no
one role is more important than any other.
Partnership
•A collaborative relationship among all stakeholders and nursing – all staff members are actively
involved in decisions and processes, have an individual role in fulfilling the mission and purpose of
the organization, and is critical to the healthcare system’s effectiveness.

14. Principles of Shared Governance
Ownership
•It describes where work is done and by whom. It necessitates all members to commit to contributing
something, to own what they contribute, and to partake in developing purposes for the work.
Accountability
•The core of shared governance. A willingness to capitalize in decision-making and prompt ownership
in any decisions It supports partnerships and is secured as staff produce positive outcomes.

15. Action Towards Shared Governance
Explain shared
governance and
its importance
• Members should
appreciate shared
governance as a
venue for change
& improvements.
It puts problem-
solving in the
hands of those
positioned to
make changes and
provide better
care.
•Create a
structure of
shared
governance
• It usually includes a
council, committee
or task force that
distinguishes and
disseminates best
practices in nursing.
The structure
includes chairs and
co-chairs and
follow rules of
order for meetings,
agendas and
minutes.
•Make shared
governance
accessible
• It should comprise a
diverse group of
staff members with
varied opinions.
Meetings should be
conducted on a
schedule that allows
for in-person, phone
or video conference
attendance and
should be accessible
to all.
•Prioritize
coaching
• Offer constant
support for
meeting planning,
data analysis and
skills development
to foster success.
Acknowledge team
members for their
accomplishments
& cascade positive
results with other
committees to
feature
accomplishments.

16. Leadership Style Also Makes a Difference…
Idealized
Influence
Inspirational
Motivation
Individualized
consideration
Intellectual
Stimulation
The way we approach leadership
creates a difference in the
accomplishment of shared governance.
Transformational leadership smooths
working with direct care nurses to
establish areas of change and solutions
for that change.
A good leader knows to direct
his/her committee members and works
with them. He/She allows nurses the
majority of the control and will offer her
expertise. He/She serves as a middleman
between the nurse committee and line
managers that make requests or lay out
goals for the committee to achieve.
Nurse leaders serve as role models
embodying the qualities of a
professional clinician.
Inspire and motivate direct care
nurses through the presentation
of vision for change.
Genuine concern for nurses’
needs and feelings. This
helps in developing trust
among staff while helping
them to self-actualize.
Challenge other nurses to be
innovative in challenging the current
situation and provide support and
encouragement.

17. Growing needs
• Today’s transformational relationship-based healthcare, which is driven by technology,
generates a new paradigm with distinctive goals and objectives in an organizational learning
environment. Leaders, administrators, and employees are learning and applying new ways
of delivering care, new technologies, and new ways of thinking and working. In the
process, they acknowledge more and more that the nurse at the point of service is key to
organizational success.
• Nurses and managers must be ready for different roles, new relationships, and latest ways
of managing. Shared governance is about stirring from a conventional hierarchical model
to a relational partnership model of nursing practice hence there is a dire need for its
adaptation in many healthcare organizations/institutions around the world.

18. Governance Models
Whole - Systems Governance
• Connects all professionals involved in the
care delivery process (i.e. nurses, physicians,
administrators and other allied health
professionals) under a structure that
incorporates clinical, support, and
organizational concerns across traditional
boundaries.
• This forms a transitional model for
ownership at all levels of the organization. It
echoes accountability at every level and
builds a seamless structure directed towards
offering health service to its community.

19. Nurse - Shared Governance
• A model of nursing management in
which the staff nurse shares responsibility
and accountability for patient care with
the clinical agency management. Shared
governance adopts a participatory style of
management and targets to achieve a high
quality of patient care and professional
nursing practice.
Governance Models

20. Professional - Shared Governance
• Dr. Robert Hess (1992) first popularized the
phrase in several peer-reviewed articles as a
multidimensional organizational
characteristic that embraces the structure
and processes by which professionals direct,
control, and regulate goal-oriented efforts
of one another. Professional governance
encompasses a continuum from traditional
to shared to self-governance.
Governance Models

21. Appreciating Shared Governance
Increased nurse satisfaction with shared decision-making and
creation of an empowered nursing workforce
Increased professional autonomy, as well as higher staff and nurse
manager retention
More effective nurse-led innovations in clinical practice thus
improving patient care outcomes
Better financial states due to cost savings/cost reductions like
harm avoidance and retention
Greater patient and staff satisfaction
Advantages

22. Appreciating Shared Governance
The model does not protect against groups ganging up on others,
pushing through a change that is not accepted by all or many of the
invested members
The process of collaborative governance, though effective, is time
consuming.
It may be difficult to reach a consensus and even if a solution is
agreed upon, the implementation may be tricky.
Roles may becomes confusing in case of large and complex
organizational structures-people may be working for individual
benefit or for a particular organization’s success.
Disadvantages

23. There’s no one right way to endorse shared governance within an organization. Facility’s
needs are different from other healthcare services, and direct care nurses have diverse opinions
and issues that must be addressed. Taking these specific issues into account, one must establish
ground rules for shared governance in a facility. Setting strong foundations for shared
governance can make or break the process.
Here are five reliable tips to strengthen any organization’s shared governance program.
Is there a best way?
1. Invest in shared governance facilitators.
• Build an internal expert on shared governance by carving out formal job duties
within existing hours of an educator, coordinator, or clinical nurse specialist. May
consider also rotation of staff through the hours on a periodic basis, leaving a
wake of experts as the years progress.
2. Evaluate effectiveness of communication mechanisms with staff.
• Ensure that the communication mechanisms, such as blogs, newsletters, listservs,
email chains, and meetings, are successfully communicating the decisions,
successes, and changes that are outcomes of the shared governance.

24. Is there a best way?
3. Focus on middle managers for implementation
• A line manager who is knowledgeable about how important the administrator's role is to enact shared governance
can support a unit’s staff to effective levels of participation. Managers need first an onboarding and then continuing
education to learn how to facilitate, incorporate, and manage activities in order to take ownership of leading and
making operational decisions.
4. Ensure shared governance is a component in every employee’s job description, peer review,
employee evaluation, and performance appraisal.
• Expectations should be well-defined to managers, the same applies to staff. Goals and behaviors
should be set for every employee in above documents. Since these said documents and processes
exist in a shared governance environment, they should be reviewed and updated regularly to keep
stride with a progressive staff and dynamic environment.
5. Market the importance of shared governance program to staff
• An empowered staff should be able to communicate concepts and the importance of shared
governance to anyone and that includes its cost effectiveness. No need to be concerned about
promoting shared governance to staff that can already voice to its worth.

25. Brooks, B., (January 31, 2004). Measuring the impact of shared governance. Online Journal of Issues in Nursing. Vol. 9 No.1, Manuscript 1a. Accessed from
www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume92004/No1Jan04/MeasuringtheImpact.aspx
Duquesne University School of Nursing. (n.d). The role of shared governance in nursing. Accessed from https://onlinenursing.duq.edu /the-role-of-shared-
governance-in-nursing/
Hawkins, M. (1997). Whole systems shared governance: Architecture for integration. Accessed from 0834209519 (ISBN13: 9780834209510)
Hess, R. (2019). Five tips for a thriving shared governance model in 2018. Accessed from https://sharedgovernance.org/?page_id=2525
Lippincott Solutions (February 27, 2019). How Shared Governance in Nursing Works. Accessed from
http://lippincottsolutions.lww.com/entry.html/2019/02/27/how_shared_governanc-oiGj.html
Lisa, L. (December 2019). The benefits of shared governance. Accessed from doi: 10.1097/01.NME.0000585088. 35054.df
Mary Regional Health (n.d). Nursing: Shared governance & professional practice model. Accessed from https://www.mauryregional.com/for-medical-
professionals/nursing/shared-governance
References

26. Olson, G. (July 2009). Exactly what is 'shared governance'. Accessed from https://www.chronicle.com/article/Exactly-What-Is-Shared/47065
Ong, A., Short, N., Radovich, P. & Kroetz, J. (October 2017). Ripple effect: Shared governance and nurse engagement. Accessed from doi: 10.1097/01.NUMA.0000524811.11040.05
Porter-O'Grady. T., (January 31, 2004). "Overview and summary: Shared governance: Is it a model for nurses to gain control over their practice?" Online Journal of Issues in Nursing Vol. 9
No. 1, Overview & Summary. Accessed: www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume92004/No1Jan04/Overview.aspx
Shared Governance: What exactly is it. (March 2012). Accessed from https://www.nursetogether.com/shared-governance-what-exactly-it/
Shared Governance LCC. (n.d). Forum for shared governance. Accessed from https://sharedgovernance.org
Shared governance: A practical approach to reshaping professional nursing practice. (2006). Accessed from http://www.strategiesfornursemanagers.com/supplemental/4428_book.pdf
These slides are uploaded for information purposes and as partial requirement of Philippine
Women's University in PhD class - Subject: Governance in Health Care Practice.
References