Shared Governance: What it is, and What it is Not

What is Shared Governance?

Shared governance. a leadership model for nursing leadership and healthcare professionals, is used to promote nurse and interprofessional empowerment, shared leadership, and accountability. Developing shared governance gives voice to front line clinicians to become more involved in the decision-making process.

Nurse leaders partner with councils or teams to share guardrails for determining solutions to issues that impact direct care employees and the services that they provide daily. Shared governance is not leaders asking for input or feedback while leaders retain the decision-making authority.

A shared governance structure creates support for personal and professional growth for all involved. It fosters a transparent review of work practices and support with a focus on evidence-based patient outcomes, that ultimately results in the best patient care.

Nursing Shared Governance

The critical work of nursing shared governance is shared decision making between nurse leaders and the point of care nurses to support things such as evidence-based practice projects, resource allocation, and new equipment purchases. 

Nursing shared governance promotes both nurse satisfaction and positive patient outcomes. Nurses take ownership for their decentralized decision-making. Nursing shared governance creates strong leadership skills for staff members.

Tips for Shared Governance

Develop Your Structure

The goal of shared governance councils or teams in shared governance is to take into consideration all clinical areas and nursing administration. This includes nurse leaders, clinical nurses, leadership groups, as well as other members of the unit/department team such as nursing assistants and unit coordinators. A great example of shared governance in nursing is having a diverse group. You will ensure you are hearing the voice of all groups impacted by the decision practicing a shared governance structure and shared governance model.

A best practice for council membership is for individuals to volunteer or be nominated by their colleagues. Creating shared governance councils will take time and effort from everyone involved. The councils will need individuals to volunteer to participate.

Structural consideration should also be given to the various levels of councils such as system, organization, unit/department, service line or specialty.

Reasonable Timeline for Implementation

For the best chances for positive outcomes, there needs to be a realistic timeline set in place. Implementing shared governance requires the acquisition of new knowledge and skills inclusive of decision-making processes, understanding of data, and action planning techniques all while forming a cohesive team. Taking the time to create your structure and processes before implementing supports long-term shared governance success.

Clinical significance

An established and functioning shared governance structure supports improve patient outcomes in healthcare organizations. Numerous research studies highlight that improvement in nursing-sensitive indicators, such as urinary tract infections and catheter-associated pressure injuries, s result from shared governance structures and processes.

Sharing these improvements with all involved, can be a motivator to expand and deepen involvement in shared governance initiatives.

Patient and Nurse Outcomes

The nursing shared governance model places the responsibility for decision-making into the hands of those who will operationalize the decision.

Decisions, regardless of if they are focused on procedures, resources, or workflow, are best made when they are aligned with the organization’s strategic plan, data driven and address the patient experience, job satisfaction, patient outcomes and safety and/or the work environment.

Shared governance improves patient outcomes, increases nurse engagement, supports retention and promote quality care, and optimize efficiency.

Shared Governance IS:

• A leadership model
• A tenant of professional practice
• Open communication between all staff members
• A way to promote staff engagement
• An expression of an organizational culture

Shared Governance IS NOT:

• A strategy that supports downsizing
• Abdication of leadership responsibilities
• Elimination of positional leadership
• Self-governance

Issues of Concern

The lack of clear understanding of the difference between participatory management and shared decision-making is the #1 concern seen in organizations. Another area of concern is when organizations try to fit the structures and processes from another organization into theirs.

No one structure fits all and time must be taken to build structures and process that fit the individual organization’s culture. Some leaders struggle with what they view as the abdication of their role or the loss of power. Uncovering and addressing these issues and concerns early is necessary to support building your shared governance culture.

Often, those not involved in councils do not understand the why or what of the work councils are doing. Sharing the outcome of council work is an important step in the development of a shared governance culture.

Shared Governance at Creative Health Care Management

Over the last four decades, CHCM has helped transform health care with Relationship-Based Care (RBC), delivered comprehensive Magnet® preparation services, and revolutionized the field of competency assessment.

Our interprofessional team has partnered with health care organizations of all sizes on five continents on everything from one-day presentations to organizational and system-wide assessments, multi-day workshops, and multi-year RBC implementations and Magnet® journeys.

At Creative Health Care Management we are experts in the structures and process that are needed to develop a robust shared governance culture. Afterall, we wrote the book…Shared Governance that Works, we work with leaders and staff an provide education that enhances the ability to make the best decisions for your organization, all the while developing a new level of ownership for work. Our philosophical approach and core values not only support staff members as they embark on increased ownership; we also support the leaders who, often have to change the way they lead.

CHCM partners with health care organizations to improve quality, safety, patient experience, staff and physician satisfaction, and financial performance by improving relationships.

We believe shared governance is a structure and process for partnership, professional autonomy, equity, accountability, and ownership. In a shared goverance culture, the responsibility, authority, and accountability for practice related decisions is placed into hands of the individuals who will operationalize the decision. It is also a strategy to develop future leaders and is a key expression of an organizations culture.