The document discusses the concept of shared governance in nursing, emphasizing the need to transition from traditional hierarchical models to participative decision-making systems that empower nurses and promote collaboration. It outlines the key principles, benefits, and challenges associated with shared governance, as well as various models for its implementation. The piece highlights that successful integration requires ongoing education, support, and adaptation to specific organizational contexts.

1. SharedGovernance in
Nursing: A dynamicfaceliftfor
empoweredpractice
by: Nashrene Ahmed Raafat Elbar, RN, MAN
Submitted to:
Dr. David Hali de Jesus, RN, PgDip, FISQua

2. DISCLOSURE
I do not have any relevant financial
relationship with commercial interest to
disclose.

3. OBJECTIVES:
 Explore the concept of Shared Governance
in Nursing
 Discuss the principles and models underpinning
practice
Identify challenges and recommendations for
effective implementation

4. 2nd HGH - Pediatric Emergency Centers Nursing Symposium
School
Absente
eism
So why are we much interested?
Switching gears
towards a shared
governance
approach is driven
by certain
‘Push Factors’
(Green and Jordan, 2002)

5. ‘From Hierarchy to Relational Partnership’
There is a need to break from the
traditional hospital governance where
nurses have little power in a rigid formal
hierarchical bureaucracy. `

6. Traditional hierarchical
governance model
Governance’s most needed upgrade
FROM THIS TO THIS
Participative decision-making
 Position-based
 Limited staff
input
 Hierarchical
communication
 WE-THEY work
environment
 Divided goals
and purpose
(Guanci, 2018)

7. 2nd HGH - Pediatric Emergency Centers Nursing Symposium
Unnamed concept of
autonomous organization,
aimed for equal nurses
voice with physicians
Decentralization
concept emerged,
adaptation in many
US hospitals
Concept of power
distribution to
formulate policy
among professionals
Researches
were carried out
& various
models existed
Shared governance is
reflected in books and
literature
Shared Governance in-progress, and still an
‘unfinished business’
To date, some ambiguity
still exist due to the
implementation of
various forms of shared
governance, and the
boundaries defining it
(Hess, 2004)

8. Key features of Shared Governance:
autonomy
independence in practice
accountability
empowerment
participation
collaboration

9. Diversity in theoretical perspectives resulted to a
variety of Shared Governance definitions:
O’Malley (1997) Hess, 1998 Porter-O’Greedy, 2001
accountability-based
governance that shares power,
control, decision-making with
professional staff within a
clinical decision-making
framework
structure & process by which
organizational participants
directly control & regulate the
many goal-oriented efforts of
other members
dynamic way of
conceptualizing, empowering
& building structures which
embodies the 4 principles:
partnership, accountability,
equity & ownership
(Anthony, 2004)

10. In simpler terms, Shared Governance:
is an organizational strategy by which
nurses can advocate for, and manage
their professional role with greater
degree of autonomy
its strategy is focused on partnership
between the organization and the
individual nurse
creates an environment where
professional accountability is respected
and encouraged
“where staff nurses move from the bottom to the center of the organization”
(Church et al, 2008)

11. 2nd HGH - Pediatric Emergency Centers Nursing Symposium
Principles of
Shared
Governance
Partnership
Collaborative relationship in decisions and processes,
links healthcare providers, the management and
patients at all points of the system
Equity
No role is more important than the other, and each
one is essential
Accountability
Investing on decision-making and ownership of those
decisions
Ownership
Recognition and acceptance of everyone’s work and
the commitment of each one to contribute
(Anthony, 2004)

12. Advantages
 Promotes greater sense
of cooperation
 Empowers nurses to have
control over their practice
 Job satisfaction
 Longevity of employment
 Improved financial picture
 Safer care and patient
satisfaction
Disadvantages
o Unrealistic expectations
o Demands energy and
time
o May cause interpersonal
conflict
o Can be complex and
challenging
Studies reported findings with mixed conclusions as to whether
shared governance improves the workplace environment.
(Anthony, 2004
McKnight and Moore, 2019)

13. 2nd HGH - Pediatric Emergency Centers Nursing Symposium
COUNCILOR MODEL
Coordinating council
integrates decisions by
managers and staff
through subcommittees
ADMINISTRATIVE MODEL
More traditional and splits
organizational chart to
focus on management and
clinical tracks CONGRESSIONAL
MODEL
Democratic and
empowers nurses to
vote on issues as a
group
Structure isVital in
Shared Governance
There are 3
general
Models that
emerged.

14. Shared Governance models can also be
categorized as:
WHOLE SYSTEMS SHARED COVERNANCE
which involves all levels of the organization, including all
disciplines, departments and employees
NURSE SHARED GOVERNANCE
strategies are focused on partnership between the organization
and the nurse
PROFESSIONAL SHARED GOVERNANCE
Creation of teams of stakeholders that are focused on
realizing goals (*new concept)
(O’May and Buchan, 1999)

15. How can nurses step-up and engage in Shared Governance?
?
?? ?

16. Shared Governance actions:
Accountability
- Nurses recognize current workplace issues and
seeks support needed to address these concerns.
- Nurses participate in development of practice
standards and quality assurance monitoring.
Empowerment
- Nurses voice is strengthened by involving them in
workplace decisions that affect patient care, such
as participation in unit-based councils.

17. Shared Governance actions:
Conflict resolution and patient
advocacy
- Nurses participate in a non-hierararchial power,
interaction in work design.
- Decision support and conflict resolution is
available at the point of care delivery, and
conflict is resolved at the level where it occurs.
- Nurses speak up to improve practices that
ensures delivery of safe care.

18. The implementation of Shared Governance is
not easy. It can be riddled with conceptual
ambiguity and resistance. Not all will share
the enthusiasm to this wonderful innovation.

19. 2nd HGH - Pediatric Emergency Centers Nursing Symposium
The journey is long and
steep. Lack of opportunities
for staff to acquire skills
leads to disengagement and
frustration.
Shared Governance requires
constant revitalization and
renewal.
Lack of researches with
rigorous designs.
Evaluation of the
process and its effects
may be difficult.
Not every environment is
conducive to shared
governance.
Shared governance
may be exclusionary
and focus on goals of
a single profession.
Roadblocks to successful implementation
(Porter-O’Grady, 2019)

20. How can we make it better?
 Establish consensus and clear
extent where governance exists
 Conduct more researches
focused on outcomes (benefits
to nurses, patients and
organizations)
 Reconcile gaps in theoretical
perspectives and variations in
implementation
 Educate, educate, educate

21. Theoretical clarity
Its association to
cost-effective care
Shared governance and the
multidisciplinary team
Transition to new
work relationships
Shared governance and
patient outcomes
Future
Direction
Areas that needs further exploration..

22. References:
Green, A. and Jordan, C. (2004). Common Denominators: Shared
Governance and Work Place Advocacy-Strategies for Nurses to Gain Control
over Their Practice. The Online Journal of Issues in Nursing. Vol. 9 No.1,
Manuscript 6.
Guanci, G. (2018). Shared Governance: What it Is and Is Not. Association for
Nursing Professional Development. Retrieved from:
https://www.anpd.org/blog/shared-governance-what-it-is-and-is-not
Hess RG Jr. (2004). From bedside to boardroom - nursing shared
governance. Online J Issues Nurs. 9(1):2. Published 2004 Jan 31.
Anthony, M. (2004). "Shared Governance Models: The Theory, Practice, and
Evidence". Online Journal of Issues in Nursing. Vol. 9 No. 1, Manuscript 4.
Church, J., Baker, P., Berry, D. (2008). Shared governance: A journey with
continual mile markers. Nursing Management, 39 (8).

23. References:
Porter-O'Grady, T. (2019) Principles for sustaining shared/professional governance
in nursing. Nursing Management (Springhouse).Vol 50 Issue 1 - p 36-41
McKnight H and Moore S. (2019) Nursing Shared Governance. In: StatPearls
StatPearls Publishing. Retrieved from:
https://www.ncbi.nlm.nih.gov/books/NBK549862/
O'May, Fiona & Buchan, James. (1999). Shared governance: A literature review.
International journal of nursing studies. 36. 281-300. 10.1016/S0020-
7489(99)00023-1.

24. Quality efforts fail because we lack “A”.
Enabler for Cultural Change
Q x
Quality solutions x
= EA
Formula for Success….
= Effective ResultsAcceptance and Accountability
Shared Governance is a journey, not a destination.

25. These slides are uploaded for information purposes and as partial
requirement of Philippine Womens’ University in PhD Class;
Subject: Governance in Healthcare Practice with
Dr. David Hali de Jesus, RN, PgDip, FISQua