Taking shared governance to the next level

Shared governance puts decision-making power into the hands of nurses who directly care for patients. Around in healthcare since the 1980s (and debuting in the business and management industry a decade before that), shared governance is increasingly recognized as a necessary component of the modern hospital and nursing culture.

“Forces such as the Institute of Medicine’s Future of Nursing Report, the American Nurses Credentialing Center’s Magnet Recognition Program, and the vital role of nursing in the redesign of healthcare have been influential,” explains a recent study in The Journal of Nursing Administration. “The complexity of today’s healthcare system makes it vital that the largest discipline in healthcare feel empowered to make decisions.”

In fact, facilities seeking the Magnet designation must have a shared governance or similar system in place before even applying for recognition. The structure should be one that “supports shared leadership and participative decision-making and promotes nursing autonomy,” advises Nurse.com.

Why the push?

Shared governance recognizes the important contributions of direct care nurses and seeks to tap into their expertise for organizational decisions. Shared governance also empowers and engages staff nurses.

“Shared governance provides an opportunity to promote leadership of the direct care nurse through involvement and control over practice decisions. Models of professional practice that increase decision making by nurses have been empirically associated with better patient and nursing outcomes,” report Sally O. Gerard, DNP, RN, CDE, CNL, Fairfield University, Fairfield, CT; Deborah L. Owens, MSN, RN, NE-BC, St. Vincent’s Medical Center, Bridgeport, CT; and Patricia Oliver, MS, a consultant in Newtown, CT, in the JONA study.

On the unit level, shared governance can take the form of unit-based practice councils. Shared governance is also in play in organization-wide nursing groups that focus on specific topics, such as research, safety, quality and professional practice.

“The key to a shared governance model,” the JONA authors write, “is the active participation of direct care nurses and the ability to make decisions about practice.”

Looking inward

If your organization offers its nurses shared governance opportunities, you may want to evaluate how staff nurses feel about the process. According to the JONA article, doing so can help facilities take their shared governance programs to the next level.

The authors describe a project in which nurses at the 476-bed St. Vincent’s Medical Center—where Owens is director of the Magnet program—were polled on their view of the shared governance culture there. Specifically, researchers wanted to know how satisfied staff nurses were with their level of decisional involvement. To do so, researchers used a scientifically valid, reliable tool called the Decisional Involvement Scale, which measures decisional involvement in a handful of areas, such as unit staffing, quality of professional practice, and professional recruitment.

The methods are explained in detail in the study. But the findings revealed some interesting takeaways for nurse leaders at the medical center by identifying areas of dissatisfaction collectively as well as for individual units. For instance, the project revealed that nurses on the oncology unit were satisfied with their input into staffing structure. However, the scale showed that those same nurses were not nearly as satisfied with their state of involvement when it came to the selection of new hires on the unit.

“This is a topic that can be addressed with collaboration of the leader and staff to involve others in the selection process,” the authors point out.

Making improvements

Meanwhile, an organization-wide finding showed that the nurses involved in committee work for 5 years or more had higher shared governance dissatisfaction scores than those who were involved for less time than that or not at all. That got nurse leaders thinking, and they came away with 3 possible explanations for the situation:

• These nurses have a greater desire for change, as evidenced by their years of shared governance commitment.
• These nurses may benefit from education on how to enact change in large organizations.
• Shared governance council formats may need to be revised to allow for greater satisfaction.

By identifying the dissatisfaction, shared governance leaders could review, reflect, and plan for improvement in the future.

“For this institution, a comprehensive evaluation of shared decision making was a valuable tool to establish a baseline of data and seek opportunities for improvement,” the authors wrote. “By being able to narrow these opportunities, organizational leaders can target the most appropriate plan for improvement, unique to the needs of clinical units.”