Shared governance is a leadership model that promotes partnership between managers and staff in decision making through structures like councils and committees. Implementing shared governance involves five steps: understanding proven approaches, identifying improvement opportunities, empowering stakeholders, accelerating implementation, and evaluating outcomes. Shared governance leads to improved patient and staff outcomes like lower infection rates and higher job satisfaction by engaging staff. Nursing shared governance specifically refers to shared decision making between nurses and leaders over areas like staffing and new equipment. It provides benefits like improved patient outcomes and nurse satisfaction.

1. SHARED
GOVERNANCE
Han Gege

2. Contents
What is shared governance
1
How to implement shared governance
2
Effects of shared governance
3
Nursing Shared Governance
4

3. What is Shared Governance?
 Shared governance is a leadership model that uses structure
and process for partnership, equity, accountability, and
ownership.
 We define it as “a leadership model in which positional
leaders partner with staff in decision making processes
while creating ownership for improvement in practice”.

4. What is Shared Governance?
Shared governance allows managers and staff to come together
in the decision-making process.

5. Practice
authority
responsibility
accountability
What is Shared Governance?

6. What is Shared Governance?
Shared governance in higher education refers to structures and
processes through which faculty, professional staff, administration,
governing boards and, sometimes, students and staff participate
in the development of policies and in decision-making that affect
the institution.

7. What is Shared Governance?
In healthcare organizations, 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.

8. Contents
What is shared governance
1
How to implement shared governance
2
Effects of shared governance
3
Nursing Shared Governance
4

9. How to implement shared governance?
There are five steps to implementing shared governance:
understanding proven shared governance approaches
identifying improvement opportunities
enfranchising and equipping key stakeholders
accelerating implementation
evaluating and revising action plans
Advisory Board. Tools for establishing a formal shared governance structure.
2014.

10. Based on this five-step model, the following actions can help an
organization implement shared governance:
Carefully plan and prepare before implementation.
Learn from organizations that have successfully implemented a
shared governance model and make sure subject experts are
present.
Assess the organization for performance improvement projects.
Create expectations and goals for staff involvement.
Hess RG Jr. Measuring nursing governance. Nurs Res. 1998;47(1):35–42.
How to implement shared governance?

11. Incorporate and communicate training and education related to
shared governance expectations and goals.
Offer frequent open forums for staff and leaders to share ideas
and information, with opportunities to ask questions.
Involve stakeholders from various levels of the organization to
work as a team on performance improvement projects, valuing
each member's input and contribution.
Develop effective infrastructure to support shared governance,
such as journal clubs to share evidence-based practice.
Hess RG Jr. Measuring nursing governance. Nurs Res. 1998;47(1):35–42.
How to implement shared governance?

12. Maintain momentum by communicating shared governance
success to all levels of staff.
Ensure that nurses feel empowered and allow them to take
ownership of decisions impacting their practice.
Measure the outcomes and impact of shared governance, such
as administering the Index of Professional Nursing Governance
survey.
Hess RG Jr. Measuring nursing governance. Nurs Res. 1998;47(1):35–42.
How to implement shared governance?

13. Shared governance leads to engaged and empowered
staff, and leads to professional growth along with better
working conditions and quality work environment.
Effects of shared governance

14. Contents
What is shared governance
1
How to implement shared governance
2
Effects of shared governance
3
Nursing Shared Governance
4

15. A lack of shared governance can also have long-term effects.
For example, a hospital is implementing a new electronic health
record (EHR). Much of the EHR is designed by senior leadership
and the vendor, resulting in countless revisions to ensure a user-
friendly system for frontline staff. Revisions to the EHR continue
to be addressed and implemented for over 2 years after the
system goes live.
Effects of shared governance

16. Patient and Staff Outcomes
Facing a competitive environment and potential staffing
shortages, hospitals have a vested interest in promoting a culture
of engagement among nurses and interprofessional partners,
who comprise the largest share of the hospital workforce.
Effects of shared governance

17. Nursing Leadership and Nursing Practice
There is a significant amount of research on the patient outcomes
that result from implementing shared governance in nursing
practice. In addition, organizations that foster employee
engagement through shared decision-making outperform their
counterparts in terms of job satisfaction and retention,
profitability, and performance.
Effects of shared governance

18. Contents
What is shared governance
1
How to implement shared governance
2
Effects of shared governance
3
Nursing Shared Governance
4

19. Nursing shared governance 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.
Nursing Shared Governance
Boswell C, Opton L, Owen DC. Exploring Shared Governance for an
Academic Nursing Setting. J Nurs Educ. 2017 Apr 01;56(4):197-203.

20. 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.
Nursing Shared Governance
Boswell C, Opton L, Owen DC. Exploring Shared Governance for an
Academic Nursing Setting. J Nurs Educ. 2017 Apr 01;56(4):197-203.

21.  The increased level of work and time commitment associated
with beginning a shared governance structure adds to the
difficulty of receiving buy-in from bedside nurses.
 Most bedside nurses are working 12-hour shifts while
balancing their home life responsibilities, and some are
working on furthering their formal education.
Nursing Shared Governance
French-Bravo M, Crow G. Shared Governance: The Role of Buy-in in Bringing
About Change. Online J Issues Nurs. 2015 Mar 19;20(2):8.

22.  All these components challenge the ability and desire to add
more to their already full plates.
 Open communication and collaboration among team members
are the best practices for overcoming these and other potential
barriers.
Nursing Shared Governance

23.  Involving the nurses who work off shifts such as nights and
weekends can provide and organization with concern.
 Reaching this population requires planning and diligence to
meet their needs and expectations.
Nursing Shared Governance

24.  Nursing leadership must take time to provide education about
the process, bring bedside nurses to the table from the start,
and instill trust.
 Training is necessary to build a foundational knowledge of what
shared governance is and how it will benefit the nursing staff and
patients within the healthcare system.
Nursing Shared Governance

25.  Robust processes and procedures to support growth are vital
to the success of any new program, but this is especially true of
shared governance.
 Following the PDSA improvement cycle will assist an organization
with developing sustainable policies and procedures during the
shared governance planning, implementation, and evaluation stages.
Nursing Shared Governance

26. Nursing Shared Governance
Improved patient outcomes are the most
significant clinical impacts associated with a
nursing shared governance structure within
healthcare organizations.
1
Improved job satisfaction among nurses is also a
positive clinical impact for those implementing a
shared governance structure.
2
Successfully shared governance programs and
structures assist healthcare organizations with
internal succession planning.
3

27. 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 using shared
governance structures and processes.
Nursing Shared Governance
1 Improved patient outcomes

28. Nurses are more engaged in policy development and revision,
helping 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.
Nursing Shared Governance
Improved job satisfaction
2

29. 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.
Nursing Shared Governance
Assist internal succession planning
3

30. Communication among bedside nurses and nursing leadership
is a critical area for successfully implementing a healthy, shared
governance structure. Frequent check-ins and clarification
meetings may need to take place early during the planning phase.
Interprofessional involvement enhances a healthcare
organization’s shared governance structure. This type of
collaboration brings all healthcare providers to the table to make
positive and meaningful changes to policies, procedures, and
projects.
Nursing Shared Governance