Shared governance in Nursing

Shared Governance in Nursing:
Turning the Gears towards Excellence
Jerome G. Oquiana
A0821721
Governance in Healthcare Practice

DISCLOSURE STATEMENT
This lecture/presentation/speaker declares no conflict of interest
and is not associated or sponsored by
any company in discussing this topic

Learning Objectives:
At the end of this presentation, the readers will be able to:
 Define what is shared governance
 Concepts of shared governance in nursing
 History of shared governance
 Contributing factors towards shared governance
 Action towards shared governance
 Growing needs in shared governance for collaboration, engagement in HealthCare Practices
 Governance Models
 Appreciate shared governance
 Implementation of shared governance

Shared Governance
 It is a model of nursing practice that is designed to integrate core valu
es and beliefs that professional practice embraces, which becomes a
means of accomplishing quality care (Anthony, 2004)
 It means giving all members of the healthcare workforce a say in
decision-making, which promotes diverse and innovative feedback
that will aid the organization's business and healthcare missions.
 It is a shared decision-making based on the principles of
partnership, equity, accountability and ownership at the point of
service.

Concepts of Shared Governance
Shared governance focuses on four main principles that serve as the foundation and the
cornerstones of the concept. Collectively, when one incorporates the four principles of
shared governance
Partnership - Developing collaboration and healthy partnerships among the
healthcare team
Accountability – Achieving clear understanding of each members role and
expectations, and taking responsibility for their actions and
decisions
Equity - focusing on having an equal stake in the outcomes of the care and
quality that the team member provides
Ownership - the success of an organization depends on how well each
member of the healthcare team performs their jobs.
into a team’s behavior, one creates a professional work environment of empowerment.

Shared Governance
Shared by Who?
It is shared decision making between the staff nurses or bedside nurses and
nurse leaders, including resources, nursing research or evidence based practice
initiatives, new equipment purchases, and staffing.
Who will benefit?
The people in the surrounding communities, our patients, the staff, and the
organization will benefit in shared governance
Who governs?
The healthcare team led by the nurse leader will be responsible for safe system
delivery of patient care, providing adequate resources. The nurse leader will be
helped by staff nurses who will be accountable for patient care outcomes.

Brief Background
of Shared
Governance
Socrates (470–399 BC), an ancient Greek philosopher, integrated shared
governance concepts into his philosophies of education. The Socratic Method
encourages students to use reason rather than appeal to authority.
A proof that philosophy, education, religion, politics, business and
management, and healthcare have all benefited from a variety of
shared governance process models implemented in many diverse and
creative ways across generations and cultures (Swihart, 2011).
The government model for the United States was established on the concepts of
shared governance— “of the people, by the people, for the people” (from
Lincoln’s Gettysburg Address, 1863)—wherein the very citizenry is directly
responsible for the government on both state and federal levels.

Brief Background of Shared
Governance
Eventually, organizations began to design formal structures and relationships around
their leaders and employees. Positive outcomes emphasized movement from point
of service outward shared governance found its way into the business and
management literature (Laschinger, 1996; O’May & Buchan, 1999).
In the late 1970s and early ‘80s, shared governance found its way into the
healthcare and nursing arenas as a form of participative management. It engaged
self-managed work teams and grew out of the dissatisfaction nurses were
experiencing with the institutions in which they practiced (McDonough, Rhodes,
Sharkey, & Good roe, 1989; O’May & Buchan, 1999; Porter-O’Grady, 1995).

Contributing Factors towards Shared Governance
 Shared governance has a decentered structure of power and decision
making.
 Shared governance is a major departure from traditional management-
drive systems. It requires commitment and investment from all of
nursing.
 Moving to shared governance affects the way in which nurses work and
relate to the organization.
 Governance structures of educational institutions directly influence the
faculty members and the staff and their occupational satisfaction.
 One challenge is how to engage and then supporting more junior nurses
in joining teams

Contributing Factors towards Shared Governance
 Providing various groups of people a share in key decision-making processes, often
through elected representation
 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.
 Applying and supporting shared governance 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.

Actions Towards Shared Governance
.
The action towards shared governance is the result of many studies. There
have been conclusions on poor collaboration and ineffective communication
among healthcare providers that can result in devastating medical errors.
The struggle to provide quality care in the highly stressful— and sometimes
highly charged—work environment today has resulted in limited success in
recruitment and retention of qualified nurses nationwide (Kohn, Corrigan and
Donaldson 1999; AACN 2002; Weinberg 2003).
Hence, the development of shared governance. The professional practice
environment of nursing care has shifted dramatically over the past generation
(AONE 2000; AACN 2002).
Rapid advances are occurring in • biotechnology and cyber-science • disease
prevention, patient safety, and management • relationship-based care •
patients’ roles in their healthcare

Growing Needs in Shared Governance
.
 Establishing clear lines for accountability for the roles in
nursing, and fully deploying shared governance to the point
of service became the next pivotal step in designing a system
that endorsed the staff nurse's authority, responsibility, and
accountability for her/his practice.
 It was an important fundamental step to create a nursing
structure whereby the nurse manager's role changed to one
of facilitator, integrator, and coordinator of the processes
that support the work of the staff nurse - empowering that
nurse to control her/his own practice.

Growing Needs in Shared Governance
.
 Today’s as 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.

Governance Models
.
The Whole-Systems Governance
Creates a transitional model for ownership across all levels of
the organization. Accountability is also reflected at each level
and creates a seamless structure directed towards he
delivery of health service to its community.
The nurses’ role in whole-systems governance is
multifaceted, occurring within the multiple levels of the
organization.  This model emphasizes that all employees
have their roles in the organization, participating as part of
the organization in the directions, policies, decisions and
objectives that set the future of an organization.

Governance Models
.
Nurse-Shared Governance
The critical concept of this type of governance is shared
decision-making between the nurse leaders and bedside
nurses.
This type of governance promotes collaboration and open
communication among the administrative leaders and
bedside nurses.
Although it promotes nurse satisfaction and positive patient
outcomes, the process of building this type of governance
and the related processes can be challenging for both leaders
and frontline nurses.

Governance Models
.
Professional-Shared Governance
It focuses on the creation of a structural framework that is
consistent with different professions.
Professional governance distinguishes itself from
management functions with its exclusive control over the
profession’s own practice. It works as a partner with the
organizations instead of being controlled or managed by
them.
Professional shared governance brings every professional
stakeholder to the table to create a team, having the focus of
realizing goals, enhancing professionalism and improving the
delivery of services.

Advantages of Shared Governance
.
Improved patient outcomes are the most significant clinical
impacts associated with a nursing shared governance
structure within healthcare organizations. For example,
numerous studies have found improved results for nursing-
sensitive indicators with the use of shared governance
structures and processes. Knowledge of this benefit should
aid in the desire for all nurses to be involved in this type of
initiative.
Effects of implementing a shared governance model included
improvement of care quality, creation and maintenance of
communication network between managers and
professionals, promotion of nurse leadership, more
autonomy for nurses in decision- making processes, greater
recognition and professional visibility of nurses, and reduced
care costs.

Advantages of Shared Governance
.
Improved job satisfaction among nurses is also a positive clinical
impact for those implementing a shared governance structure.
Nurses are more engaged in policy development and revision,
which helps to give them a better overall picture of the hospital
environment. Nurses are also more satisfied when they see their
ideas at work within the various patient care improvement projects.
Giving the nurse a sense of belonging and loyalty to their healthcare
organizations, which also increases morale and performance.
Successfully shared governance programs and structures assist
healthcare organizations with internal succession planning. Bedside
nurses become actively engaged with decision making, policies, and
procedures, which helps them to see their leadership skills come to
life. Nurses move from being members to the chairperson of the
shared governance councils. Active learning occurs during this
participatory process.

Disadvantages of Shared Governance
.
 Efficiency will be limited because it lengthens the time required to
complete the critical processes such as planning and assessment.
 Quality of decisions will be affected by opinions from members not
adequately qualified to speak on the issues.
 The nurse managers may have additional responsibility as they may
have no previous experience in decision making rather than their
patient care assignments.
 May result in a unfavorable amount of power, control, and
advantage to certain staff.
 Senior and first-line managers could not adapt to or accept the
radical philosophical change and so they were unable to empower
their staff and to provide the necessary reinforcement needed to
ensure the success of shared governance.
 Lowered morale in the wake of layoffs, together with union
grievances, and lack of clarity of the role to be played by union
representatives in shared governance may produce conflict and
confrontation.

Implementation of Shared Governance
.
How can I help make Shared Governance work in my unit;
 Engage
 Commit
 Collaborate
 Deliver
 Encourage (Ahmed Zinhom, 2015). Shared Governance)
Managers can play a key role in the successful implementation of shared
governance in the appropriate context of higher education institutions.
The senior or higher level managers of educational institutions can
empower themselves & their staff in participatory skills along with
providing suitable resources of work serving as a suitable model of
participation (Atashzadeh-Shoorideh et al, 2019).

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 year’s progress.
2. Evaluate effectiveness of communication mechanisms with staff. • Ensure that the
communication mechanisms, such as blogs, newsletters, list serves, email chains,
and meetings, are successfully communicating the decisions, successes, and changes
that are outcomes of the shared governance.
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.

Is there a best Way?
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.

Your Leadership Style Also Makes a Difference
Transformational leadership facilitates working with direct care nurses to determine areas of
change & solutions for that change. In general, four characteristics help to define
transformational leadership (Lippincott Solutions,2019):
1. Idealized influence: Nurse leaders serve as role models for direct care nurses,
embodying the qualities of a professional clinician.
2. Inspirational motivation: The ability to inspire and motivate direct care nurses through
the presentation of your vision for change.
3. Individualized consideration: This is true concern for your nurses’ needs and feelings. This
component helps you develop trust among nursing staff while helping them to self-
actualize.
4. Intellectual stimulation: You challenge other nurses to be creative in challenging the
status quo. You help your nurses achieve higher levels of performance with your support
and encouragement. (Lippincott Solutions (2019). How shared governance in nursing works)

Ten (10) essential actions for nurse leaders
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
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 (Marky Medeiros (2018).

References
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/Volume920
04/No1Jan04/MeasuringtheImpact.aspx
Hess, R. (2019). Five tips for a thriving shared governance model in 2018. Accessed from
https://sharedgovernance.org/?page_id=2525
Flynn, M. K. (1997). Correlates of staff nurse work satisfaction in hospitals with shared governance (Order No.
9728363). Available from Nursing & Allied Health Database. (304418490). Retrieved from
https://search.proquest.com/docview/304418490?accountid=38643
HCPro, Inc (2006). Shared Governance: A practical approach to reshaping professional nursing practice. Retrieved
June 19, 2020 at http://www.strategiesfornursemanagers.com/supplemental/4428_book.pdf 4. Marky Medeiros
(2018).
McKnight H, Moore SM (2019). Nursing Shared Governance. Retrieved June 18, 2020 at
https://www.ncbi.nlm.nih.gov/books/NBK549862/
Porter-O'Grady, Tim (2001). Is Shared Governance Still Relevant? Retrieved June 07, 2020 at Journal of Nursing
Administration, 31(10), 468-473.
http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=ovfte&NEWS=N&AN=00005110- 200110000-00010.
Swihart, D. (2011), Shared Governance: A Practical Approach to Transform Professional Nursing Practice, Second
Edition 2nd Edition

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

Shared governance in Nursing

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