Everything you need to know about Shared Governance in Nursing Organization.

1. Title Image: Hospital Meeting Concept (Rawpixel, 2020)
NURSE SHARED-GOVERNANCE
Are You Ready for Your Role?
Mark Joseph Julian RN, MAN

2. What is SHARED GOVERNANCE (SG)?
• Initially introduced about 20 years ago to provide strategies for
empowering nurses and a framework for organizing the work of nursing
within any given organization (Porter-O’Grady, 2001).
• It makes every healthcare staff feel that he or she is “part manager” with
a personal investment in the success of the organization. (Swihart, 2006).
• It is a model of nursing practice that is designed to integrate core values
and beliefs that professional practice embraces, which becomes a means
of accomplishing quality care (Anthony, 2004).

3. Who Are Benefited by SG?
• Shared governance provides organizational support for direct-care
nurses and that enables them to become committed to quality
nursing practice within their organizations (Green & Jordan, 2004) .
• Nurse staff are able to contribute and participate in creating
policies and budgets within most health care organizations through
shared governance (Hess, 2004).
• Nurse administrators report enhance nurse retention in their
organization (Hess, 2004) as it increases job satisfaction of staff
nurses (Institute of Medicine, 2004).

4. History of Shared Governance
Socrates (470-399 BC), an ancient Greek
philosopher, incorporated shared
governance notions into his philosophies
of education. The Socratic Method
(answering an inquiry with an inquiry)
demands for the teacher to enable the
student's autonomous learning as the
teacher guides him or her via series of
questions. The Socratic Method thus
allows students to use reasoning rather
than appealing to authority (Swihart,
2011 as cited in Nurse Insider, 2019). Figure 1: Statue Head of Socrates (Biography, 2019)

5. History of Shared Governance
The United States government model was
established on the concepts of shared
governance-"of the people, by the people,
for the people" (Lincoln's Gettysburg
Address, 1863)-in which the very citizenry
is directly accountable for the government
on both state and federal claims. Political
adaptation of this model of shared
governance are in effect in the European
Union and the United Nations, wherein
individual countries do share in the
decision-making process on joint
international matters (Swihart, 2011 as
cited in Nurse Insider, 2019). Figure 2: Abraham Lincoln (Britannica Encyclopedia, 2020)

6. History of Shared Governance
Shared governance eventually discovered
its way into the enterprise and
management literatures. Organizations
started to formulate formal structures and
affiliations around their leaders and
employees. Positive outcomes established
movement from point of service outward.
This changed from the more traditional,
hierarchical method of moving from the
organization downward or central
approach as previously utilized (Swihart,
2011 as cited in Nurse Insider, 2019). Figure 3: Comparison of Centralized from Decentralized Structure (Anderson, 2018)

7. History of Shared Governance
In the late 1970s and early 1980s,
shared governance finally settled its
way into the healthcare and nursing
field as a form of participative
management. It occupied self-
managed work teams and was utilized
out of the discontent nurses were
experiencing in the institutions which
they practiced (Swihart, 2011 as cited
in Nurse Insider, 2019).
Figure 4: Nurses station with student nurses circa 1970, Chestnut Hill Hospital,
Philadelphia (Barbara Bates Center for the Study of the History of Nursing, 2020).

8. The Principles of Shared Governance
1. Accountability Accountability determines the foundation
for structuring SG strategies (Metcalf &
Tate, 1995; Porter-O’Grady, 1991, 2001,
& 2003b). The essential element of
nursing accountability is authority to make
decisions for all professional nursing
responsibilities. Being an accountable
professional demands nurses to
acknowledge current workplace issues
and know how to address the support
needed to settle these issues in the
workplace (Green & Jordan, 2004).
Figure 5: “No More Blaming Others” (Eilertsen, 2012)

9. The Principles of Shared Governance
2. Empowerment Shared governance provides great sense
of empowerment to the nurse to provide
quality patient care. It gives strategies
focused on strengthening nurses’ voice
and ensures their participation in
workplace decisions that affect patient
care. For instance, in creating
organizational policies, such as nurse
staffing, nurses can partake on it through
the hospital’s nurse management council
(Green & Jordan, 2004).Figure 6: Nurse Empowerment (Heroman, 2015)

10. The Principles of Shared Governance
3. Conflict Resolution
SG strategies embrace principles of conflict
resolution that assist nurses in determining
and dealing conflict. Organizations that
effectively integrate conflict resolution
strategies into their shared governance
approaches provide support for nurses to
learn and practice these highly specialized
and important negotiation skills. Effective SG
policies presents specific network of
communication for conflict resolution within
individual organizational settings and
sufficiently train nurses to effectively handle
conflicts arising either from patient care or
physician-related issues (Green & Jordan,
2004).
Figure 7: Nurses in Conflict (Brilliant Nurse, 2017)

11. The Principles of Shared Governance
3. Patient Advocacy
Patient advocacy is considered a cornerstone of the
nursing profession in which patients depend on
nurses to ensure that they receive proper care
(Green & Jordan, 2002). SG supports the "rights"
framework/ policies that it relates assurance of a safe
health care environment for delivery of patient care
(Green & Jordan, 2004).
Nowadays, errors and adverse events are credited to
problems in complex systems and technologies. Such
situations demand that nurses emphasize their voices
to safeguard patient advocacy. SG requires a
structural mechanism within organizations whereby
nurses are encouraged to speak up to improve
practices, thus promoting the safest and best
outcomes for patients (Green & Jordan, 2004).
Figure 8: Nurses as Patient Advocate (Chicago, 2018)

12. The Shared Governance Models
1. Whole Systems Governance
The Whole-Systems Shared Governance is a
framework that binds the point of service
(patient care) and sustaining the work processes
of the organization at the same time as
identifying every component part of the system.
Hence, it brings nursing staff and managers
together in a service partnership (Porter-O'Grady
et al., 1997).

13. 1. Whole Systems Governance
In whole-system shared governance,
the system is said to “dwell" where it
provides service. It upholds that all
members of the organization have a
stake in the system, and each part of
the system supports the whole.
Similarly, an issue in one part of the
system that affects the whole system
because teams, not individuals are the
basic unit of work (Caramanica, 2004)
Figure 9: National Model Clinical Governance Framework in Australia
(Australian Commission on Safety and Quality in Health Care, 2019)

14. The Shared Governance Models
2. Nurse- Shared Governance
This management process model empowers all members of the
healthcare workforce to have a stand in decision-making
process, thus encouraging distinct and creative contribution that
will assist progress the business and healthcare missions of the
organization. Therefore, it makes every nursing staff feel like he
or she is “part manager” with a personal stake in the success of
the enire the organization (Summa Health, 2020).

15. 2. Nurse- Shared Governance
Summa Health (2020) adopts the Nursing Shared
Governance Model in which the unit-based clinical
practice councils discuss and resolve nursing practice
and deal with issues that affect the unit. The Nursing
Leadership Council, Nursing Recruitment and
Retention Council, and Nursing Research Council
include discussions for settlements and
communication of strategies to promote shared
governance or review research studies that enhance
practice. Concerns affecting multiple units may
proceed to the Nurse Practice Councils for further
discussion and resolution. The Nursing Cabinet
(nursing leadership group) is at the midpoint of the
model providing support to all Councils.
Figure 10: Nurse -Shared Governance Model ( Summa Health, 2020)

16. The Shared Governance Models
3. Professional-Shared Governance
Hess (2017) defined shared governance as just a single
component of a larger concept-professional governance.
Professional shared governance is "a multidimensional
organizational characteristic that encompasses the structure and
processes by which professionals direct, control and regulate
goal-oriented efforts of one another” (Hess, 1988, p. 35).

17. 3. Professional-Shared Governance
Hess (2017) explains professional- shared
governance “as an overarching concept, it
is proposes that professional- shared
governance encompassed a continuum of
traditional governance (the bureaucracy
that most of us have been brought up
with), to shared governance, to self-
governance (a not-so-hypothetical
situation where nurses might own a
hospital and employ managers to help
them run it)” (p.1).
Figure 11: Shared Governance of UMC Health System (2020)

18. The Move Towards Shared Governance
• Nurse have learned to play games compulsory to survive by developing undeclared
tactics (Foster, 1992, as cited by Porter-O’Grady, 1992).
• During this time of change, both managers and the staff were experiencing
difference in their work . The workload was more complicated, workers were better
educated and no specific person could be depended on to provide all necessary
information and answer (Foster, 1992, as cited by Porter-O’Grady, 1992).
• The changes in today’s healthcare are pushed by nursing’s need to move in
innovative direction (Foster, 1992, as cited by Porter-O’Grady, 1992).
• Hence, organization resorted to various governing structures such bureaucratic,
decentralization and eventually shared governance.

19. Bureaucracy
vs
Decentralization
vs
Shared Government

20. The Nursing in Bureaucratic Structure
• Defined as “government characterized by
specialization of functions, adherence to
fixed rules and a hierarchy of authority”
(Webster, 2020).
Foster (1992) as cited by Porter-O’Grady,
(1992), defined nursing bureaucracy as
follows:
• Less work is achieved in bureaucracy,
although this structure was formulated to
create efficiency and centralize control.
• “Organization resulted in layers of
personnel between the staff and the
highest in the level of management” (p.81).
• Top-down and one-way communication
through tight centralized control.Figure 12: Bureaucratic Model in Nursing Organization (Porter-OGrady, 1992)
Hospital
Administrator
Director of
Nursing
Assistant Director
of
Nursing
Head Nurse
Charge Nurses
Staff Nurses

21. The Nursing in Decentralized Structure
Oh the other hand, Foster (1992) as cited by Porter-
O’Grady, (1992), defined nursing decentralization as
follows:
• Lessening the layers of management by relocating the
authority, responsibility and decisions to the lower levels
of the hierarchy.
• But accountability and decisions still remain in the
management level .
• Organization is produced from layers of personnel
between the staff and the highest in the level of the
hierarchy.
• The nurse manager has now the responsibility for the
decision on the unit instead of the director or
administrator although it is not really his role as a
manager to perform those clinical activities.
• This situates both the staff and the managers in
untenable circumstances.
Figure 13: Distribution Icon (Lago, 2019)

22. The Nursing in Shared Government
• Shared Governance lets nurses who are working in groups, to be cooperatively responsible
towards achieving goals, direct themselves (Jones, 2004) and thus have more autonomy
and control over the work and in access to information (Perley & Raab, 1994).
• It empowers of all members of the nursing workforce in actively partaking place in decision-
making by promoting diverse and innovative input that will help further the strategy of the
organization (Swihart, 2006).
Who share? Who Govern?
Figure 14: Shared Governance: New Way Nurses are being Heard (CHI Health, 2020).

23. Implementation of Shared Government
Foster (1992), as cited by Porter-O’grady (1992), clearly explained the best ways of
executing shared governance in nursing
1. Staff are nominated by the peers to the position they assume.
2. Clinical nurses rather than managers become representative on all committees that
affect nursing practice.
3. Clinical nursing staff are granted the accountability for all issues that relate to nursing
practice e.g.- standards, quality assurance activities and policies.
4. Nurse managers are held responsible for managing the budget and allocation ensuring
that sufficient number of staff are hired and to assure interface between nursing and
departments that reinforce nursing function appropriately rather than being solely
responsible for clinical decisions.
5. The clinical nurse is now the focal point of hospital’s mission of patient care- the nurse
executive no longer sees herself as the representative of the nursing service and
encourages clinical nurse as the representation of highest level of organization.
6. A staff nurse may represent the nursing staff in the board of directors of the hospital. If
not applicable, other methods may need to be instituted to recognize staff nurse in the
organization’s power structure.

24. Implementation of Shared Government
6. Staff has a shared task with management in the issues regarding salary, expenses,
allocation, staffing and working conditions . Management has no longer the complete
control over this.
7. By laws or by policies define operations and structure of the nursing organization. This
delineates clear and exact definition of roles within department of nursing. To assure that
process are not casually changed by the current or new management, rules should be
confirmed by broad of trustees.
8. Clinical staff are represented within the executive level of the department of nursing. The
structure appointed to accomplish this is often comprised by executive group of staff and
management. This executive group would address and settle issues for the entire
department e.g.- budget and rules.
9. There is a definite process for all members of the department to meet and review
relevant issues and the work of the department.
10. A meeting, be it annual or quarterly, should be conducted at which leadership may be
nominated.

25. Shared Governance
Advantages
It brings out the use of nurses’
clinical knowledge and expertise
to develop, direct and sustain their
own professional practice
(Eisenhower Health, 2020).
It assures accountability and decision-
making through shared responsibility
and built-in checks and balances
(Eisenhower Health, 2020).
Figure 15: Nurse in Professional Practice
(Penn Nursing, 2020).
Figure 16: Checks and Balances
(History, 2020).

26. Shared Governance
Advantages
It preserves and reinforces a
decentralized management
structure, giving an overall sense
of empowerment as well as
requiring extra effort from those
individuals who have active roles
in the process (Purontaus, 2010).
It allows nurses to link with
colleagues and to collaborate
among units and departments
(Purontaus, 2010).
Figure 17: Decentralization
(Assignment Point, 2020).
Figure 18: Nurse Networking (AHNA, 2016).

27. Shared Governance
Disadvantages
It slows down decision-making
because there are more
individuals involved than the
traditional hierarchy (Purontaus,
2010).
It hampers implementation
because it takes more time and
effort to communicate and achieve
consensus, and to plan and
assess when there are more
participants (Purontaus, 2010).
Figure 19: Conflicts in Decision Making
(Kumar, 2017).
Figure 20: Homer on duty
(Judgement and Decision-Making, 2015).

28. Shared Governance
Disadvantages
Strategic initiatives such as
implementing new programs and
services can be delayed because
administrators are busy elsewhere
(Purontaus, 2010).
Not every member of the team is
capable of governance and this may
result to work ineffectiveness.
Otherwise too many capable leaders
may result to clash and conflict.
Figure 21: Work Delay(Hruby, 2020).
Figure 21: Clash of Ideas (Hospital News, 2020).

29. References:
1. AHNA. (2017). Nurse Networking Calls. retrieved from https://myemail.constantcontact.com/News-From-AHNA--
April-7--2017-.html?soid=1101540285162&aid=QifbpyQuVxA
2. Anderson, D. (2018) Tyranny of Decentralization. Retrieved from https://medium.com/@droplister/the-tyranny-of-
decentralization-3c3819fc6f6e
3. Anthony, M. (2004). "Shared Governance Models: The Theory, Practice, and Evidence". Journal of Issues in Nursing, 9
(1), Retrieved from:
www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume9200
4/No1Jan04/SharedGovernanceModels.aspx
4. Assignment Point. (2020). Disadvantages of Decentralization. Retrieved from
https://www.assignmentpoint.com/business/management/disadvantages-of-decentralization.html
5. Australian Commission on Safety and Quality in Health Care. (2019). National Model Clinical Governance Framework.
Retrieved from https://www.safetyandquality.gov.au/topic/national-model-clinical-governance-framework
6. Barbara Bates Center for the Study of the History of Nursing. (2020). Nurses station with student nurses circa 1970,
Chestnut Hill Hospital, Philadelphia. Retrieved from https://www.pinterest.de/pin/377739487470952870/
7. Biography. 2019. Socrates. Retrieved from https://www.biography.com/scholar/socrates
8. Brilliant Nurse. (2017). Nurses’ Conflict resolution. Retrieved from https://brilliantnurse.com/9-nurses-conflict-
resolution-2-638/
9. Britannica Encyclopedia. (2020). Abraham Lincoln. Retrieved from https://www.britannica.com/biography/Abraham-
Lincoln
10. Caramanica, L. (2004). "Shared Governance: Hartford Hospital's Experience". Journal of Issues in Nursing, 9 (1).
Retrieved from :
www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume9200
4/No1Jan04/HartfordHospitalsExperience.aspx
11. CHI Health. (2020). Shared Governance: New Way Nurses are being Heard. Retrieved from
https://www.chihealth.com/en/about-us/press-room/news-center/2020-news/shared-governance-new-way-nurses-
are-being-heard.html
12. Chicago, L. (2018). The Role of the Nurse as Patient Advocate. Retrieved from https://absn.luc.edu/blog/role-of-
nurse-patient-advocate/
13. Eilertsen, C. (2020). No More Blaming Others. Retrieved from https://cheriepower.wordpress.com/2012/07/07/no-
more-blaming-others/
14. Eisenhower Health. (2020). Nursing Shared Governance. Retrieved from https://eisenhowerhealth.org/health-
services/other-health-services/nursing/nursing-shared-governance/
15. Green, A. & Jordan, C. (2002). Workplace advocacy and workplace issues. In B. Cherry & S. Jacob (Eds.), Contemporary
nursing: Issues, trends and management. St. Louis, MO: Mosby
16. Green, A. & Jordan, C., (2004). "Common Denominators: Shared Governance and Work Place Advocacy – Strategies
for Nurses to Gain Control over Their Practice". Online Journal of Issues in Nursing, 9 (1). Retrieved from:
www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume9200
4/No1Jan04/SharedGovernanceandWorkPlaceAdvocacy.aspx
17. Heoman, S. (2015). Speak Up, Nurses! Retrieved from https://blog.nursingjobsonly.com/tag/nurse/
18. Hess, R. (1988). Measuring nursing governance. Nurs Res.47(1):35-42
19. Hess, R. (2004). "From Bedside to Boardroom – Nursing Shared Governance". Online Journal of Issues in Nursing, 9
(1). Retrieved from:
www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume9200
4/No1Jan04/FromBedsidetoBoardroom.aspx
20. Hess, R. (2017). Professional Governance. JONA 47 (1), pp 1-2. Retrieved from
https://www.nursingcenter.com/pdfjournal?AID=3916813&an=00005110-201701000-
00001&Journal_ID=54024&Issue_ID=3916812
21. History. (2020) Checks and balances. Retrieved from https://www.history.com/topics/us-government/checks-and-balances
22. Hospital News. (2020). A hidden truth: Hostility in healthcare. Retrieved from https://hospitalnews.com/a-hidden-truth-
hostility-in-healthcare/
23. Hruby, J. (2020). Procrastination businessman which delay his work for later. Retrieved from
https://www.123rf.com/photo_38829128_stock-vector-vector-illustration-procrastination-businessman-which-delay-his-
work-for-later-simply-modern-flat-de.html
24. Institute of Medicine (2004). Keeping patients safe: Transforming the work environment of nurses. Washington, DC: The
National Academies Press.
25. Jones, L. & Ortiz, M. (1989). Increasing nursing autonomy and recognition through shared governance. Nursing
Administration Quarterly, 13(4), 11-16
26. Judgement and Decision-Making. (2015). Aging and Decisions from Experience. Retrieved from https://j-
dm.org/archives/3068
27. Kumar, V. (2017). Myths Related to Making A Right Career Decision. Retrieved from https://thecompanion.in/myths-
related-making-right-career-decision/
28. Lago, A. (2019). The Utility Platform Player in an Era of Decentralization. Retrieved from https://www.tdworld.com/utility-
business/article/20972631/the-utility-platform-player-in-an-era-of-decentralization
29. Lincoln, A. (1863). The Gettysburg Address. Retrieved from
http://www.abrahamlincolnonline.org/lincoln/speeches/gettysburg.htmswihart
30. Merriam Webster. (2020). Bureaucracy. Retrieved from https://www.merriam-webster.com/dictionary/bureaucracy
31. Metcalf, R., & Tate, R. (1995). Shared governance in the endoscopy department. Gastroenterology Nursing, 18(3), 96-99.
32. Miller, C. (2018). Coffee Table Meeting. Retrieved from
https://thekeep.eiu.edu/cgi/viewcontent.cgi?article=1776&context=jcba
33. Nurse Insider. (2019). History and development of shared governance. Retrieved from hcpro.com/NRS-266847-975/From-
the-staff-development-bookshelf-History-and-development-of-shared-governance.html
34. Penn Nursing. (2020). Team care in education and practice. Retrieved from https://www.nursing.upenn.edu/practice/
35. Perley, M. & Raab, A. (1994). Beyond shared governance: Restructuring care delivery for self-managing work teams. Nursing
Administration Quarterly, 19(1), 12-20
36. Porter-O’Grady, T (2002). Nurses as partners. Hospitals & Health Networks/AHA, 76(12), 10,12.
37. Porter-O’Grady, T (2003a). A different age for leadership, Part 1. Journal of Nursing Administration, 33(2), 105-110.
38. Porter-O’Grady, T. (2001). Is shared governance still relevant? Journal of Nursing Administration, 31(10), 468-473.
39. Porter-O’Grady, T. (2001). Is shared governance still relevant? Journal of Nursing Administration, 31(10), 468-473.
40. Porter-OGrady, T. (1992). Implementing shared governance: creating a professional organization. St. Louis: Mosby Year Book
41. Porter-O'Grady, T., Hawkins, M. & Parker, M. (1997). Whole-Systems Shared Governance: Architecture for
Integration. Gaithersburg, MD: Aspen Publishers.
42. Purontaus, V. (2010). Pro’s and Con’s of Shared Leadership. Retrieved from
http://sunsnou.pbworks.com/w/page/12055668/The%20pro%27s%20and%20con%27s%20of%20shared%20leadership
43. Rawpixel. (2020). Hospital Meeting Concept. Retrieved from https://www.rawpixel.com/search?similar=145948&page=2
44. Summa Health. (2020). Nurse -Shared Governance Model. Retrieved from
https://www.summahealth.org/supportservices/nursingservices/shared-governance
45. UMC Health System. (2020). For Nurses- Shared Governance. Retrieved from
https://www.umchealthsystem.com/professionals/nurses/shared-governance

30. These slides are uploaded for
information purposes and as partial
requirement of
Philippine Women's University
in
PhD class.
Subject: Governance in
Health Care Practice.
Background Picture : Coffee Table Meeting (Miller, 2018).