The document discusses shared governance in nursing, emphasizing its role in empowering nurses through participative management and decision-making. It outlines four foundational principles: partnership, equity, ownership, and accountability, which collectively create a culture of collaboration and professionalism. Implementing shared governance has been associated with improved patient outcomes, increased job satisfaction among nurses, and enhanced organizational effectiveness, though it may also pose challenges in terms of decision-making efficiency.

1. Achieving Nursing
Excellence thru
Shared Governance
Submitted by: QUEEN JBLYN YANGA ABDULLAH MAN, RN
PhD in Nursing student (O.G)
Reviewed by: Dr. David de Jesus

2. What is shared governance?
• Shared governance is a management model that promotes nurses’ control of
their practice and the environment in which they practice. It represents a
radical departure from traditional management models in which nurses have
little power within formal hierarchic structures.
• It has been described as a dynamic process that facilitates a framework for
an organizational format. This includes empowerment and point-of-service
decision making as key structures in organizations that value the principles
of partnership, accountability, equity, and ownership (Porter-O'Grady, 2001).
• Shared governance is a concept for introducing participative management
into the nursing care delivery system. Advocates believe this provides a
genuine sharing of power in decision making.
• It is a structure that promotes a culture of empowerment, autonomy, and
decision making that occurs at the front line by the staff that performs the
work.

3. Principles of Shared Governance
 Shared governance focuses on four main principles that serve as the
foundation and the cornerstones of the concept. Collectively, when
one incorporates the four principles of shared governance
(partnership, accountability, equity, and ownership) into a team’s
behavior, one creates a professional work environment of
empowerment.

4. I. Partnership
 Partnership. Developing collaboration and healthy partnerships among
the healthcare team is essential to teambuilding, relationship
development, and strengthening professional practice. Each team
member’s role is important in helping the organization to meet its overall
goals. This importance is further demonstrated when staff are included in
practice decisions and process changes. Partnerships development can
occur both internally and externally in an organization.
 Internal partnerships among healthcare team members (e.g., physicians,
nurses, laboratory workers, and pharmacists) are important not only to
improve communications among the team, but also to deliver safe
patient care.
 External partners (e.g., community, organizations) can assist to
strategically align organizational goals such as expanding services within
a community and building strong alliances. Partnering with public and
private organizations can also further advance public policy related to
nursing practice.

5. II. Equity
 Equity. Equity within a shared
governance structure focuses on all
members of the team having an equal
stake in the outcomes of the care and
quality that they provide. No one role is
more important than the other in
providing safe and efficient care. Each
member has specific knowledge and
skills that, when combined with those of
the entire healthcare team, deliver
quality to patients in the most efficient
way.
 Collaboration and team effort are
essential for healthcare members to
achieve optimal outcomes (Bates, 2004).
 Equity is achieved when team members
come prepared to work within their
scope of practice and role within the
organization to achieve an overall goal
(Bates, 2004).

6. III. Ownership
 Ownership. Ownership is based on the fact that success of an organization
depends on how well each member of the healthcare team performs their
jobs. Bates (2004) describes staff paying attention to detail and showing pride
in their work as signs of ownership.
 Ownership is being responsible for the end product or outcome, whether good
or bad. In ownership, the individual goals become team goals, because the
goal of the team cannot be achieved without each person skillfully performing
his or her roles and integrating his or her efforts (Bates, 2004).

7.  IV. Accountability
 Accountability. Accountability is when all
staff members achieve a clear
understanding of their role and
expectations, and take responsibility for
their actions and decisions; this is the
core of shared governance.
 Accountability is usually delegated to a
role by someone who has the power to
delegate it. In order to operationalize
professional accountability there must be
autonomy, authority, and control of
practice.

8. Concepts of shared governance in
nursing
 1. Moves the professional from subservience to autonomy by giving them authority
over practice decisions.
 2. It values the contributions of the professional by recognizing their clinical
expertise.
 3. It builds trust by teaching groups to work together in an environment of
openness, self-disclosure, and inner honesty.
 4. It clarifies communication and reduces uncertainty by giving staff nurses direct
access to information.
 5. It promotes quality performance by giving those doing the work of the
organization the authority for practice decision making.
 6. It results in high productivity, low absenteeism, and low turnover by creating a
work environment where job satisfaction is high.
 7. It values and promotes advancement in and of the profession.

9. Who shares governance?
 Membership in shared governance may be limited to registered nurses (RNs)
only or may include all personnel involved in patient care (e.g., LPNs, nurses’
aides, respiratory therapists).
 Those who believe that shared governance is a professional model limit the
membership to RNs (Porter-O’Grady, 1987).
 However, nurse executives have indicated a need to include all care providers
in their shared governance models (Pinkerton, 1989).

10. Who governs?
 The typical structure consists of the following councils: (a) nursing practice,
(b) quality improvement (or evaluation), (c) education and/or research, (d)
peer accountability, and (e) coordinating (or management).
 Unit committees generally mirror the council structure in committee type.
 Staff nurses from unit committees are elected to represent their respective
units on each of the councils. Issues or problems that arise at the unit level
are brought to the council meetings by the unit representative if they involve
issues other that those related to their unit.

11. Who benefits?
Advocates of shared governance believe this provides
a genuine sharing of power in decision making. The
expected outcomes are:
(a) higher retention rates
(b) renewed awareness of organizational strengths,
and
(c) recognition of the organizational weaknesses,
threats and opportunities.
 Shared governance contributed to the decreased
use of agency nurses and decreased costs of
orientation and recruitment related to nurse
turnover.
 They also demonstrated improved quality of care,
along with increased satisfaction of nurses and
physicians.
 Increased in team cohesiveness, communication,
and decision making.
 Nurses had a higher job satisfaction, an increased
perception of giving high quality care, and
increased decision making among the nurses and
peer support.

12. Background on the emergence of shared
governance
 Nurse leaders, Dr. Timothy Porter-O'Grady and Sharon Finnigan, in the mid
80's, piloted a nursing shared governance model that enhanced professional
accountability at St. Joseph's Hospital in Atlanta, Georgia (Porter-O'Grady &
Finnigan, 1984).
 Philosophy, education, religion, politics, business and management, and
healthcare have all benefited from various shared governance process models
implemented in many diverse and creative ways across generations and
cultures. For example:
 In the 19XXs, shared governance found its way into the business and
management literature (O’May and Buchan 1999; Laschinger 1996; Peters
1991; Walton 1986; Peters and Waterman 1982). Organizations began to
design structures and relationships among their leaders and employees. They
emphasized making decisions from the point of service on instead of from the
organization downward.

13.  In the late 1970s and early 1980s, shared governance formally found its way
into the healthcare and nursing arenas, growing out of nurses’ dissatisfaction
with the institutions in which they practiced (O’May and Buchan 1999; Porter-
O’Grady 1995; McDonagh et al 1989; Cleland 1978). They started to use it as a
form of participative management, using self-managed work teams.

14. Contributing factors towards shared
governance
 First was a nursing administration model for nurse retention developed by Curran and Minnick
(1989). They acknowledged the complexity of studying staff nurse retention and identified the
market conditions interacting with the institutional environment, rewards, and individual nurse
employee. This model, a circular, interdependent approach rather than the traditional linear
framework, cited shared governance as one area to examine for improving nurse retention.
 The past two decades in health care have been a time of change, with economics driving
restructure and reengineering of health care systems. The effects of managed care and
reimbursement by diagnosis-related groups on the health care economy led to restructuring and
redesign initiatives that emphasized efficiency, flattened layers of nursing leadership, and
decreased nurses' trust in hospital administrators. Nursing leaders' effectiveness diminished as
nurse executives' and nurse managers' roles and scope of responsibility expanded outside of nursing
care units.
 Long-term issues facing nursing include another personnel shortage, as well as profound concern
for patient safety in today's health care system. These two themes-the national nursing shortage
and patient safety-are driving forces that support shared governance as a practice model.

15. Action towards shared governance
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). Hence, the development of shared
governance.
The professional practice environment of nursing care has
shifted dramatically over the past generation (AONE 2000; AACN
2002). Rapid advances are occurring in
• biotechnology and cyber-science
• disease prevention, patient safety, and management
• relationship-based care
• patients’ roles in their healthcare (i.e., they are active
partners, not just passive recipients)

16. Growing needs in shared governance for
collaboration and engagement in Health Care
Practices
Flattening the nursing hierarchy, establishing clear lines for accountability for
the roles in nursing, and fully deploying shared governance to the point of
service became the next pivotal step in designing a system that endorsed the
staff nurse's authority, responsibility, and accountability for her/his practice.
It was an important fundamental step to create a nursing structure whereby
the nurse manager's role changed to one of facilitator, integrator, and
coordinator of the processes that support the work of the staff nurse -
empowering that nurse to control her/his own practice.

17. Governance Models: Whole-systems shared
governance
 It is a structure that supports the point of service
(patient care), sustaining the work processes of the
organization while addressing every component part of
the system, bringing nursing staff and managers
together in a service partnership (Porter-O'Grady et al.,
1997).
 Nursing shared governance model was piloted in order
to enhance professional accountability.
 Whole systems shared governance creates a transitional
model for ownership at all levels of the organization. It
reflects accountability at every level and creates a
seamless structure directed towards providing health
service to its community.

18. Nursing Shared Governance
 It is shared decision making between the bedside
nurses and nurse leaders, which includes areas such as
resources, nursing research/evidence-based practice
projects, new equipment purchases, and staffing. This
type of shared process allows for active engagement
throughout the healthcare team to promote positive
patient outcomes and also creates a culture of
positivity and inclusion, which benefits job satisfaction.
 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.

19. Professional Shared Governance
 It focuses on the creation of a structural framework for
nursing practice consistent with the frameworks that govern
other major professions.
 Professional governance isn't a management strategy, model,
tactic, approach, or operational component. Rather, it
reflects an understanding that the needs and requisites of
effectively governing a profession are specifically and
significantly different from those that affect an employee
workgroup.
 Professions are required to govern themselves in the best
interests of those they serve, evidenced in standards of
knowledge generation and implementation, education,
practice, indicators of quality/impact, competency
requirements, ethics, disciplinary processes, professional
behaviors, and the requisites of licensure.

20. Advantages of Shared Governance
 Improved patient outcomes are the most significant
clinical impacts associated with a nursing shared
governance structure within healthcare organizations.
Numerous studies have found improved results for
nursing-sensitive indicators such as catheter-associated
urinary tract infections, hospital-acquired pressure
ulcers, falls with injuries, and central line-associated
bloodstream infections with the use of shared
governance structures and processes. Knowledge of
this benefit should aid in the desire for all nurses to be
involved in this type of initiative.
 Effects of implementing a shared governance model
included improvement of care quality, creation and
maintenance of communication network between
managers and professionals, promotion of nurse
leadership, more autonomy for nurses in decision-
making processes, greater recognition and professional
visibility of nurses, and reduced care costs.

21.  Improved job satisfaction among nurses is also a positive clinical impact for
those implementing a shared governance structure. Nurses are more engaged
in policy development and revision, which helps to give them a better overall
picture of the hospital environment. Nurses are also more satisfied when they
see their ideas at work within the various patient care improvement projects.
Giving the nurse a sense of belonging and loyalty to their healthcare
organizations, which also increases morale and performance.
 Successfully shared governance programs and structures assist healthcare
organizations with internal succession planning. Bedside nurses become
actively engaged with decision making, policies, and procedures, which helps
them to see their leadership skills come to life. Nurses move from being
members to the chairperson of the shared governance councils. Active
learning occurs during this participatory process.

22. Disadvantages of Shared Governance
 Efficiency will be limited because it lengthens the time required to
complete the critical processes such as planning and assessment.
 Quality of decisions will be affected by opinions from members not
adequately qualified to speak on the issues.
 The nurse managers may have additional responsibility as they may have
no previous experience in decision making rather than their patient care
assignments.
 May result in a unfavorable amount of power, control, and advantage to
certain staff.
 Senior and first-line managers could not adapt to or accept the radical
philosophical change and so they were unable to empower their staff and
to provide the necessary reinforcement needed to ensure the success of
shared governance.
 Lowered morale in the wake of layoffs, together with union grievances,
and lack of clarity of the role to be played by union representatives in
shared governance may produce conflict and confrontation.

23. Why implement shared governance?
 Various rationales are reported for introducing shared governance. Nursing
shortages is one reason given (Kovner et al., 1993). When staff shortages
occur, the task of providing continuity and goal setting in patient care
becomes more difficult, but the framework of shared governance applied on a
patient care level is one method claimed to improve delivery of quality care
(McDonagh et al., 1989). Analyses of nursing shortages are the frequently
cited reasons including a lack of autonomy in practice, low pay, poor prestige,
and poor working conditions (Deremo, 1989), to which a major contributing
factor may be the highly bureaucratic structures of hospitals. Shared
governance, operating within a professional practice framework, is claimed to
address the administration and practice factors contributing to these
shortcomings (Dennis, 1991).
 There is no best time but now to implement shared governance in nursing, it
has been credited to be the answer to retention, nursing shortages, advancing
the nursing profession, and expanding nurses' autonomy for their practice and
work life of nurses.

24.  Implementing shared governance, or any accountability-
based partnership governance, is a journey and not an
end in itself. It is not something that one can do
overnight, and it is not something that really has an end.
As staff nurses grow in their governance role, there will
always be continuing alignment of what encompasses
their authority, responsibility, and accountability for
patient care. Managers will undergo subsequent changes
in their role as well. Shared governance is definitely a
means to empowering staff nurses so that they have
control over practice and work life (Caramanica, L.
2004).

25. References:
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governance: a false start. The Nursing clinics of North America, 27(1), 11–22.
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27. This presentation is uploaded
for information purposes only
and as a partial requirement
for PhD in Nursing for the
subject of Governance in
Health Care Practice - 3rd
Trimester.
20th June 2020