1.
D R . A N J A L A T C H I M U T H U K U M A R A N
V I C E P R I N C I P A L
E R A C O L L E G E O F N U R S I N G
S A R F R A Z G A N J , E R A U N I V E R S I T Y
L U C K N O W - 2 2 6 0 0 3
GOVERNANCE IN NURSING

2.
Content of the chapter
 Introduction
 Definition
 Meaning
 Aim
 Concepts
 Principles
 Background /history of shared Governance
 Shared frame work
 Action towards the shared governance
 Shared governance model
 Advantages

3.
Shared governance
Introduction :
 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).

4.
Governance in Nursing
 Governance in healthcare is referred to as clinical
governance, “a system through which NHS
organisations are accountable for continuously
improving the quality of their services and
safeguarding high standards of care by creating an
environment in which excellence in clinical care will
flourish”.

5.
Governance, patient safety and quality
 Governance in healthcare is referred to as clinical
governance, “a system through which health
organizations are accountable for continuously
improving the quality of their services and
safeguarding high standards of care by creating an
environment in which excellence in clinical care will
flourish”.
 It involves monitoring systems and processes to
provide assurance of patient safety and quality of
care across the organization.

6.
Aims of Shared Governance
1. Empowerment of staffs directed at increasing nurses
authority and control over their nursing practice.
2. Improves nurses perception of their job & work
environment with appropriate authority & accountability.
3. Improves professional autonomy, as well as higher staff &
nurse manager retention.
4. Greater patient and staff satisfaction.
5. Improve patient care outcomes.
6. Better financial states due to cost saving/ cost reductions.
(HCPro, Inc, 2006. Shared Governance)

7.
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.

8.
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
 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

9.
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 Accountability
 Defined by outcomes
 Self-described
 Embedded in roles
 Dependent on partnerships
 Shares evaluation
 Contributions-driven value Characteristics of Accountability and
responsibility
 Defined by functions
 Delegated
 Specific tasks/routines dictated
 Isolative
 Supervisor evaluation
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

10.
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.
Sources: (O’May and Buchan 1999; Porter-O’Grady
1995; McDonagh et al 1989; Cleland 1978)

11.
Shared Governance Framework

12.
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, & management
 Relationship-based care,
 Patients’ roles in their healthcare
Source:(AONE 2000; AACN 2002)

13.
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)

14.
Nurse Co-Ordinating Council

15.
Continued
 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
Sources: (Kohn, Corrigan and Donaldson 1999; AACN
2002;Weinberg 2003)

16.
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)

17.
Councilor model
Five areas of
accountability
Practice
Quality improvement
Education
Research
Management

18.
Continued
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)

19.
Continued
 This model
transpires
communication
and coordination
of activities from
executive level
down to smaller
councils.
Administrative
model

20.
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)
 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.

21.
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.
Source:(HCPro, Inc (2006). Shared Governance: A practical
approach to reshaping professional nursing practice)

22.
The disadvantages of shared governance
 While the shared governance model exists and is
popularly utilized, it is not perfect.
 The model does not protect against groups ganging up on
others, pushing through a change that is not accepted by
all or many of the invested members.
 The disadvantage could be due to:
 • Poor communication
 • Resistance to change
 • Lack of Interest
 • Lack of concern
 • Poor planning

23.
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.
Sources:(Porter-O'Grady, Tim (2001). Is Shared
Governance Still Relevant?)

24.
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.
Sources:(Porter-O'Grady, Tim (2001). Is Shared
Governance Still Relevant?)

25.
Stage Three
 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.
Source: (Porter-O'Grady, Tim (2001). Is Shared
Governance Still Relevant?)

26.
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 implementation:
 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).

27.
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).
 10 essential actions for nurse leaders)

28.
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)

29.
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