2. • 1.Definition and aims of shared governance
• 2.History of Shared Governance
• 3.Principles of nursing sharing governance
• 4.Benefits of shared governance
• 5.The Different Models
• 6.Values and importance
• 7.How to implement shared governance in
nursing
4. • Shared governance in nursing is a nursing practice model that integrates
core values and beliefs embraced by professional practice to pursue and
achieve quality care.
• It is a working model characterized by participatory decision-making in
which nurses and other interdisciplinary team members follow organized
decision-making processes regarding quality improvement, practice
standards, professional development, and research. Tim Porter-O'Grady,
a shared governance pioneer, defines shared governance as "a structural
model through which nurses can express and manage their practice with
a higher level of professional autonomy.”
Definition of shared governance
5. • Nursing Shared Governance is a pillar of the ANCC Magnet culture.
Utilizing this approach in the hospital setting allows for better nurse
satisfaction and improved patient outcomes.
• The process of building this type of structure and the related processes
can be challenging among both nurse administrators and bedside nurses.
Open communication and collaboration among team members are the
best practices for overcoming these and other potential barriers.
Aims of shared governance
6. • Shared governance shifts the focus from a top-down management style
to a collaborative focus from the administrative team to the nurses
providing care at the bedside.
Aims of shared governance
8. • In the 1980s, the shared-governance leadership model was popularized
so registered nurses (RNs) could take control of decision-making in
clinical settings. Nearly 40 years later, shared governance has become a
mainstay of Magnet hospitals and medical centers nationwide.
History of Shared Governance
9. • Shared governance in nursing allows RNs to meet goals outlined in the
Institute of Medicine’s landmark report, The Future of Nursing: Leading
Change, Advancing Health. The report advocates for nurses to practice to
the full extent of their education and to participate in nonhierarchical
decision making. Shared governance increases nurse engagement,
improves patient outcomes and allows hospital administrators to optimize
efficiency, increase nurse retention and promote quality care, a study in
The Journal of Nursing Administration found.
History of Shared Governance
10. Shared Governance in Nursing
Shared governance in nursing was popularized in 1985 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.”
11. Shared Governance in Nursing
When the American Nurses Credentialing Center (ANCC) developed its
Magnet Recognition Program for hospitals and medical centers, it included
shared governance as a provision for excellence. Facilities can design their
shared governance framework for a personalized experience. Rhonda
Collins, DNP, RN, chief nursing officer (CNO) at the healthcare
communications company Vocera, said shared governance models are
numerous and diverse.
12. Shared Governance in Nursing
Collins, in Magnet Hospitals and Shared Governance: Empowering Frontline
Nurses, said front-line nurses benefit from shared governance because it allows
them to thrive.
“Shared governance is focused on empowering the people who work every day
making life better for patients and families,” Collins said.
Collins stated that when she worked as a CNO at a Magnet hospital, committees
were established across the various nursing disciplines – ICU, labor and delivery,
NICU, medical/surgical and others. The committees, made up of nurses who
worked in the units, met monthly to discuss issues of importance, including policy
and practice. A house-wide practice council, made up of one representative from
each committee, made decisions and recommendations that would impact the
entire nursing body.
Collins said shared governance models are only successful when nurses and
management support the core values.
14. Cooperation
Creates professional empowerment through the collaborative relationships of
all the stakeholders
Essential to building relationships
Involves all staff members in decisions and processes
Equality between members in decisions and processes
Links healthcare providers & patients
Principles of Shared Governance
15. Equity
Maintains a focus on services, patients and staff
Integrates roles and relationships into the structures and processes needed to
achieve positive patient outcomes
No role is more important than another
Each team member is essential in providing safe and effective care
Principles of Shared Governance
16. Accountability
Accountability is the core of shared governance,Willingness to invest in decision-
making ,Accepting ownership of decisions,Defines roles, not jobs; cannot be
delegated,Used interchangeably with responsibility and allows for evaluation of
role performance,Facilitates partnerships for sharing decisions and is secured in
the roles by staff producing positive outcomes.
Principles of Shared Governance
17. Equity
Maintains a focus on services, patients and staff
Integrates roles and relationships into the structures and processes needed to
achieve positive patient outcomes
No role is more important than another
Each team member is essential in providing safe and effective care
Principles of Shared Governance
19. Creation of an empowered nursing workforce
Increased professional autonomy
Increased staff and job satisfaction
More effective nurse-led innovations in clinical practice
Focus on enhancing quality of patient care
Improved financials due to harm avoidance and retention
Benefits of shared governance
21. There are several types of nursing shared
governance models. Each hospital or healthcare
organization determines which models are most
appropriate to meet their needs. Smaller
organizations may implement only one model,
while larger corporations or healthcare facilities
may use several, depending on their needs and
goals. The following are examples of the four
most common models of shared governance in
nursing.
Professional practice models
22. Unit-Based Systems Model:
This type of nursing shared governance model is tailored to a specific nursing unit.
The purpose of Unit-Based shared governance is for nurses and nurse leaders to
work together to make clinical and business decisions relevant to the delivery of
nursing care in their respective unit(s).
Professional practice models
23. Council Model of Care Management:
The council model of shared governance in nursing uses any number of
department-level councils to coordinate administrative and clinical activities. This
model is the most popular shared governance in nursing model. This model allows
nurse-directed councils to develop and implement nursing practice. With this model,
management's role is primarily supportive and facilitative, with practitioners at the
point of care guiding and directing nursing practice. Councils include evidence-
based practice, recruitment and retention, clinical practice, and unit-based councils.
Professional practice models
24. Administrative Model:
This model of nursing shared governance reflects a level of executive coordination
overseeing the activities of smaller councils.
Professional practice models
25. Congressional Model:
The congressional model of shared governance in nursing involves the central
collaboration of members across the healthcare organization. The members meet
as one council. The congressional model is the model where all nursing staff
belong, and work is assigned to cabinets. Although this model is not used as
frequently as others, some research indicates satisfaction with this model is similar
to the satisfaction level of those participating in the council model of care
management.
Professional practice models
27. In fact, Gen Guanci, RN and Creative HealthCare Management consultant, said
shared governance could not be successful without the backing of nurse managers.
Guanci, in Nurse Manager’s Role in Shared Governance and Unit Councils, said
nurse managers support shared governance in several ways:
Acting as a developmental facilitator
Helping committees function smoothly without taking charge
Helping committee members see all sides of an issue
Coaching committee members on the process and role
Addressing questions without attending meetings
Serving as a guide and catalyst for action
Fostering creativity, productivity and ownership
Developing Core Values in Shared Governance
28. Clinical staff members should understand that shared governance is a venue for
change and improvements. Shared governance puts problem-solving in the
hands of those positioned to make changes and provide better care.
RNs implementing shared governance should understand that it is not intended
to add additional work. Instead, it refocuses efforts at points of need. It allows
staff nurses to provide focus and direction for optimal health outcomes.
Importance of Shared Governance
30. 1. Establish a Steering Committee: All nursing shared governance models
should have a steering committee. The steering committee should represent
nurses from all clinical areas and nursing roles. Diversity among committee
members helps to ensure the perspectives of nurses from all levels are
represented.
2. Determine Criteria for Accepting Volunteer Memberships: Each council should
have membership criteria to ensure invitations are extended to those most
appropriate to fill the membership role.
How to implement shared governance in nursing
31. 3. Elect or Appoint Chair and Co-Chairs: Although the goal of shared governance
in nursing is to have a team approach to decision-making, there remains a need
to have a spokesperson(s) to bring ideas or concerns to the appropriate
department head. Therefore, once a committee is established, facility
administrators may opt to appoint a chair and co-chairs or allow the committee
members to vote.
4. Develop Councils: Some organizations ask for staff nurse volunteers, while
others choose to hold an election to determine council members. A few
examples of types of shared governance councils include unit-based councils,
specialty nursing councils, coordination councils, and leadership councils.
How to implement shared governance in nursing
32. 5. Create a Mission Statement: Each committee exercising shared governance
should have a mission statement relevant to the needs and goals of their unit or
organization. In most cases, each committee member makes suggestions for
what should be included in the mission statement; then, the committee-
appointed or elected chair and co-chairs create a final draft for approval by
members.
6. Establish Bylaws: Bylaws are the governing rules by which an organization
operates. It is essential to establish bylaws before implementing any shared
governance nursing model. Bylaws for shared governance should include
determining the maximum number of members, meeting schedule and cadence,
How to implement shared governance in nursing
33. 5. Create a Mission Statement: Each committee exercising shared governance
should have a mission statement relevant to the needs and goals of their unit or
organization. In most cases, each committee member makes suggestions for
what should be included in the mission statement; then, the committee-
appointed or elected chair and co-chairs create a final draft for approval by
members.
How to implement shared governance in nursing
34. 6. Establish Bylaws: Bylaws are the governing rules by which an organization
operates. It is essential to establish bylaws before implementing any shared
governance nursing model. Bylaws for shared governance should include
determining the maximum number of members, meeting schedule and cadence,
term limits for members, plans for member turnover, and a written policy of
confidentiality and open communication. Additionally, the bylaws should include
guidelines for bringing issues to the council for consideration.
How to implement shared governance in nursing
35. 7. Educate Nurses in All Clinical Areas About the Shared Governance Model and
Their Role: Once the type of nursing shared governance model is determined,
nurses in the relevant clinical area should be educated about the purpose of the
model and their role in implementing shared governance.
8. Establish Guidelines for Bringing Issues of Concern Before the Council for
Consideration: As with any successful organization or committee, there should
be clear guidelines for how issues are presented to the council, the anticipated
timeframe for having the issue addressed, and how decisions will be made
announced.
How to implement shared governance in nursing
36. 9. Establish a Preferred Method of Communication for Staff of All Levels of the
Organizations: Depending on the type of organization where shared governance
is implemented, committee or council members may work alternating shifts or
opposite shifts from one another. Establishing a preferred method of
communication allows team members to know the expectations for
communication and what to anticipate regarding responses to communication.
How to implement shared governance in nursing
37. 10. Determine a Timeline for Implementation: Establishing protocol and
implementing measures to promote shared governance in nursing requires work.
Timelines may differ depending on your organization's nursing culture and its
willingness to accept change. It is essential to set reasonable timelines which
allow for appropriate planning and implementation to ensure success.
How to implement shared governance in nursing
