Shared Governance

1. Shared Governance in Nursing
Prepared by: Dave Fernandez
Doctor of Philosophy in Nursing
Philippine Women's University, Manila
June 20, 2020
Reviewed by: Dr. David Hali De Jesus

2. Shared Governance
Is a practice model in nursing designed to integrate core
values in nursing practice in improving patient care
outcomes (McKnight H, Moore SM, 2019. Nursing Shared Governance).
Shared Governance is a shared decision making based on
four principles; partnership, equity, accountability, and
ownership at the point of service (HCPro, Inc, 2006. Shared Governance).

3. Concept of Shared Governance
Who shared? 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 benefits? It’s the people in the surrounding communities,
our patients, and the staffs, and the organization.
Who govern? The nurse manager/leader is responsible for
safe system delivery of patient care, providing adequate
resources. Staff nurses are accountable for patient care
outcomes.

4. Four Principles of Shared Governance
1.Partnership- is the collaboration of the healthcare workers
and patients in the health systems. It is important in
maintaining relationship, decision making & processes, each
members have a key role in fulfilling the organizations mission
& purpose (Porter-O’Grady and Hinshaw 2005; Batson 2004).
2. Equity- the best method for integrating staff roles &
relationships into structures & processes to achieve positive
patient outcomes. It maintains a focus on services, patients, &
staff; is the foundation & measure of value; & says that no one
role is more important than any other (Porter-O’Grady and
Hinshaw 2005; Batson 2004; Porter-O’Grady, Hawkins,
and Parker 1997).

5. Four Principles of Shared Governance
3. Accountability- is the core of shared governance. It is often
used interchangeably with responsibility & allows for evaluation of
role performance. It supports partnerships & is secured as staff
produce positive outcomes (Porter- O’Grady and Hinshaw 2005;
Batson 2004).
Accountability
 Defined by outcomes
 Self-described
 Embedded in roles
 Dependent on partnerships
 Shares evaluation
 Contributions-driven value
Characteristics of Accountability and responsibility
Responsibility
 Defined by functions
 Delegated
 Specific tasks/routines dictated
 Isolative
 Supervisor evaluation
 Tasks-driven value
(Adapted from T. Porter-O’Grady and K. S. Hinshaw 2005)

6. Four Principles of Shared Governance
4. Ownership- recognition & 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 (Porter-
O’Grady and Hinshaw 2005; Batson 2004;
Koloroutis 2004; Page 2004).

7. Brief background on the emergence of
shared governance
History of Shared Governance…
 In the late 1970s and early 1980s, 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.
(O’May and Buchan 1999; Porter-O’Grady 1995; McDonagh et al 1989; Cleland 1978)

8. Action towards shared governance
The professional practice environment of nursing care has
shifted dramatically over the past generation. Rapid advances
are occurring in;
 Biotechnology and cyber science,
 Disease prevention,
 Patient safety, & mgt
 Relationship-based care,
 Patients’ roles in their healthcare
(AONE 2000; AACN 2002)

9. Action towards shared governance
Economic constraints related to service reimbursement and
corporatism have forced healthcare systems to save money
by;
 Downsizing the professional workforce,
 Changing staffing mixes
 Restructuring/reorganizing services,
 Reducing support services for patient care
 Moving patients more rapidly to alternative care settings
or discharge
(AONE 2000; AACN 2002)

10. Growing needs in shared governance for
collaboration, engagement in HealthCare Practices
 Poor collaboration and ineffective communication
among healthcare providers 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)

11. Aims of Shared Governance
Empowerment of staffs directed at increasing nurses
authority and control over their nursing practice.
 Improves nurses perception of their job & work environment
with appropriate authority & accountability.
 Improves professional autonomy, as well as higher staff &
nurse manager retention.
 Greater patient and staff satisfaction.
 Improve patient care outcomes.
 Better financial states due to cost saving/ cost reductions.
(HCPro, Inc, 2006. Shared Governance)

12. Shared Governance Models
1. Councilor model
 The councilor model features hospital level councils, with
some models including additional unit-level councils or an
additional coordinating council overseeing operations.
 It is the most common used by magnet hospitals.
Unit councils- it empowers bedside nurses by giving them control
over nursing practice via councils established on their units. Unit
based councils were incorporated into the hospital-wide shared
governance structure and encouraged staff participation, resulting in
increased employee engagement, satisfaction, and decreased turnover .
(Robert G. Hess, Jr (2014). "From Bedside to Boardroom – Nursing Shared Governance)

13. Councilor model
Five areas of accountability
Practice
Quality improvement
Education
Research
Management

14. Shared Governance Models
2. Administrative model
 refers to the traditional bureaucratic structure that splits
the organizational chart into two tracks with either a
management or clinical focus, although the membership in
both tracks often encompass both managers and staff as
implementation progresses.
(Robert G. Hess, Jr (2014). "From Bedside to Boardroom – Nursing Shared Governance)

15. Shared Governance Models
 This model transpires
communication and
coordination of activities
from executive level
down to smaller councils.
Administrative model

16. Shared Governance Models
3. Congressional model
Relies on a democratic component to empower nurses to
vote on issues as a group.
Nursing staff belonged to a congress and committees
submitted work to a governance cabinet for administrative
action .
(Robert G. Hess, Jr (2014). "From Bedside to Boardroom – Nursing Shared Governance)

17. Shared Governance Models
 The committees
composed of a Staff Nurse
as Administrative Chair,
and representatives of
staffs, and administration.
 The nursing committee
chairs & nursing
administrators compose
of nursing council that
make the final decisions
on recommendations
from the committees.

18. Appreciate Shared Governance
Advantages
 Longevity of employment
 Increased employee
satisfaction
 Better safety & healthcare
 Improve patient
satisfaction
 Shorter lengths of stay
Disadvantages
 Resistance from Nurse
managers to change their
roles from autocratic
decision makers to
consultants, teachers,
collaborators, & facilitators
of shared decision making.
 Not all nurses want share
decision making.
 Requires long term
commitment on employee
and the organization.(HCPro, Inc (2006). Shared Governance: A practical
approach to reshaping professional nursing practice)

19. Process of successful empowerment & the
structuring of shared governance
 Stage One: Creating the Requisite to
Change Person and System.
 The organization-wide must acknowledgement that something
significant is underway.
 There must be a sense of mission experienced by everyone & an
understanding that there is no reverting to old patterns of behavior &
its supporting structure.
 Critical efforts to change the patterns of leadership & the behavior of
managers are a major part of the first steps in initiating sustainable
change. This stage lays the groundwork for undertaking the
subsequent stages of change.
(Porter-O'Grady, Tim (2001). Is Shared Governance Still Relevant?)

20. Process of successful empowerment & the
structuring of shared governance
 Stage Two: Undertaking Structural Changes
Supporting New Behaviors
 It is where the team-based processes, councils, and partnership
structures are designed and constructed to support the expectations
for accountability and shared decision making.
 This stage is important because new and different formats for
interaction, work, and decision making are generated in a way that
requires different performance and also challenges not yet
extinguished behaviors valued in past models of structure and
expectation.
(Porter-O'Grady, Tim (2001). Is Shared Governance Still Relevant?)

21. Process of successful empowerment & the
structuring of shared governance
 Stage Three: Reinforcing & Sustaining New
Structure & Behavior
 Reinforcing the underlying format and patterns of interaction
assures that the infrastructure (information, policy, locus of control,
team-based work processes) is advanced to every aspect of the system’s
way of doing business.
 The leaders make sure that what emerges is not person dependent
and cannot be vacated by the unilateral act of any key player in the
system.
 Empowerment becomes a way of life for the people and the system.
(Porter-O'Grady, Tim (2001). Is Shared Governance Still Relevant?)

22. 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).

23. Implementation of shared governance
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). Shared governance councils10 essential actions for nurse leaders)

24. Implementation of shared governance
Your Leadership Style Also Makes a Difference
The approach leadership also makes a difference in the success of shared
governance. 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)

26. References
1. Ahmed Zinhom (2015). Shared Governance. Retrieved June 19, 2020 at
https://www.slideshare.net/AHMEDZINHOM/shared-governance-52677290
2. Atashzadeh-Shoorideh et al (2019). Factors predisposing to shared governance: a qualitative study.
Retrieved June 07, 2020 at BMC Nursing (2019) 18:9. https://doi.org/10.1186/s12912-019-0334-2
3. 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). Shared governance councils10 essential actions for nurse leaders. Retrieved May
16, 2020 at www.nursingmanagement.com
5. Lippincott Solutions (2019). How shared governance in nursing works. Retrieved June 07, 2020 at
http://lippincottsolutions.lww.com/blog.entry.html/2019/02/27/how_shared_governanc-oiGj.html
6. McKnight H, Moore SM (2019). Nursing Shared Governance. Retrieved June 18, 2020 at
https://www.ncbi.nlm.nih.gov/books/NBK549862/
7. 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.
8. Robert G. Hess, Jr (2014). "From Bedside to Boardroom – Nursing Shared Governance". Online Journal
of Issues in Nursing. Vol. 9 No.1, Manuscript 1. Available:
www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/V
olume92004/No1Jan 04/FromBedsidetoBoardroom.aspx

27. Shared Governance
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