This document discusses shared governance in nursing. It defines shared governance as a model that allows for decentralized decision-making and increased empowerment. It moves from a traditional hierarchical structure to a relational partnership model. Key aspects of shared governance include responsibility, accountability, and authority. It also discusses principles like partnership, equity, accountability, and ownership. Implementation of shared governance takes 3-5 years and reflects a cultural change. There are different models of shared governance structures. While it has advantages like increased satisfaction and autonomy, it also has challenges to implement.

1. Shared
Governance in
Nursing
By: Lorna Cynthia Lorenzo
Governance in Healthcare Practice

2. What is
Shared
Governance
A model that allows for decentralized decision-
making, increased ownership and
accountability in nursing, practice, and
empowerment within the organization.
Is about moving from a traditional hierarchical
model to a relational partnership model of
nursing practice.
Key Indicator of excellence in nursing practice

3. 1.1 Concept
of Shared
Governance
Responsibility- the clear and specific allocation of
duties to achieve desired results. Individuals
cannot accept responsibility without a level of
authority.
Accountability- reflecting on actions/ decisions
and evaluating their effectives.
Authority- the right to act and make decisions in
the areas where one is given and accepts
responsibility. Levels of authority determine a
person’s right to act in the areas he or she is
given.

4. Data gathering
Data gathering + recommendations
Data gathering + recommendations
(pause) + act
Act and inform/ update
Four levels
of authority

5. 1.1 Principles of Shared Governance
Partnership-
links healthcare
providers,
patients,
stakeholders
Equity- no one
role is more
important than
any other to
achieve positive
patient
outcomes. Each
member of the
team is
essential.
Accountability-
core of shared
governance.
Willingness and
responsibility in
decision-
making.
Ownership-
designates
where work is
done and by
whom. Requires
commitment
and
participation.

6. 1.2 Who Shared
Shared
Governance
Organization
Clients
Patients
Society
Employees

7. 1.3 Who Governs
Nursing governance extends
the rules to nurses
Control over practice
Society grants professionals, by virtue to
their specialized knowledge, the right to
control their own activities (Green, 1966;
Merton, 1960)

8. 1.4 Who
Benefits
 Employees- longevity of employment
and increase employee satisfaction
 Patients- greater patient satisfaction
and shorter length of stay
 Organization- advance business and
healthcare missions
 Surrounding Communities- better
safety and healthcare, cost-effective
service delivery.
-Philosophy, education, religion,
politics, business and management.

9. 2. Background of Shared Governance
Christman (1976) first introduced the yet0unamed concept in his
description of the autonomous nursing organization, which give
nurses equal voice with physicians within the hospital
Cleland (1978) the label of shared governance first appeared in
nursing literature in Cleland’s adaptation of a university model of
faculty governance.

10. 2. Background of Shared Governance
St. Joseph’s Hospital in Atlanta, St. Michaels’s Hospital in Milwaukee,
Carondelet St. Mary’s Hospital in Tucson, and Rose Medical Center in
Denver= documented early implementation sites in major hospitals.

11. 2.1 Contributing factors towards shared
governance
 Late 1970s and early 1980s:
-Due to growing dissatisfaction of nurses with their institution, shared
governance was introduced into the healthcare and nursing.
-They started to use it as a form of participative management, using self
manage work teams.

12. 2.2 Action towards shared governance
Be clear about what
shared governance
is
01
Help staff members
understand why
shared governance
is important
02
Orient council
chairpersons on the
basics of planning
and running
meetings
03
Cultivate a sense of
ownership
04
Encourage a
continuous focus on
mission and vision
05

13. 2.2 Action towards shared governance
PROVIDE COUNCIL
MEMBERS WITH
PROTECTED TIME
TO MEET
06
INCLUDE STAFF IN
COUNCIL
DEVELOPMENT OR
REDESIGN
07
COACH AND
MENTOR
CHAIRPERSONS
08
RECOGNIZE
EXCELLENCE
09
STUDY THE
SUCCESSES (AND
STRUGGLES) OF
OTHERS
10

14. 2.3 Growing needs in shared governance for
collaboration, engagement in HealthCare Practices
Interprofessional involvement enhances a healthcare organization’s shared governance structure.
Collaboration brings all healthcare providers to the table to make positive and meaningful changes
to policies, procedures, and projects.
Completing pulse checks to determine the current state of the shared governance structure is key
to success and continued improvement and evolution such as National Database of Nursing
Sensitive Quality Indicators (NDNQI) database, the Practice Environment Scale of the Nursing Work
Index (PES-NWI), and Hospital Consumer Assessment of Healthcare Providers and Systems
(HCAHPS).

15. 3. Governance Models

16. 3.1 Councilor Model
 Coordinating council integrates decisions made by managers and staff
in sub-committees

17. 3.2 Administrative Model
 Resembles a more traditional bureaucratic structure that splits the
organizational chart into two tracks with either management of
clinical focus, although the membership in both tracks often
encompass both managers and staff as implementation progresses.

18. 3.3 Congressional Model
 Relies on a democratic component to empower nurses to vote on
issues as a group

19. 4. Appreciate Shared
Governance
4.1 The advantages and
disadvantages of shared
governance

20. Advantages:
INCREASE NURSE
SATISFACTION WITH
SHARED DECISION-
MAKING
INCREASE PROFESSIONAL
AUTONOMY
GREATER PATIENT AND
STAFF SATISFACTION
IMPROVED PATIENT CARE
OUTCOMES
BETTER FINANCIAL
STATUS DUE TO COST
SAVINGS/COST
REDUCTION

21. Advantages:
BETTER RELATIONSHIP
AND TEAM HARMONY
FEWER CONFLICTS JOB SATISFACTION COMMUNICATION,
COLLABORATION,
PROFESSIONAL GROWTH
LOWER TURN OVER

22. Disadvantages:
Complex and challenging framework
May cause discomfort as nurses learns new
skills to enhance empowerment and
excellence.
Structures and processes are different in
every organization
The purpose and focus can become distorted
or lost as members rotate on and off the
council.

23. Disadvantages:
Increased level of work and time
commitment associated with beginning
a shared governance structure

24. 5. Implementation of Shared Governance
Implementation reflects a cultural
change that takes 3-5 years to embed
(Porter-O’Grady, 19996)
Timelessness of decision making is
affected by the organization location
of shared governance.

25. 5. Implementation of Shared
Governance
ASSUMPTIONS ( HESS, 1996) WHEN SHARED
GOVERNANCE MODELS ARE IMPLEMENTED,
IT IS ASSUMED THAT GOVERNANCE IS
REDISTRIBUTED.
ORGANIZATIONS THAT IMPLEMENT SHARED
GOVERNANCE PROGRAMS CREATE NEW
ORGANIZATIONAL STRUCTURES, SUCH AS
COMMITTEE- VEHICLES THAT GATHER
MANAGERS AND STAFF TOGETHER TO MAKE
DECISIONS.

26. 5.1 Is there a best way?
Participation by researchers, administrators, nurse
executive and staff for a common understanding of
shared governance concept
Increase scientific rigor in research
Strategies such as workshop and focus groups

27. Thank You!

28. References:
 Anthony, M. (2004), Shared Governance Models: The Theory, Practice, and Evidence, Online Journal of Issues Nursing
9(1)7
 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. Vol. 9 No.1, Manuscript 6
 Heather McKnight, H., Moore, S. (2019), Nursing Shared Governance
 Hess, R. (2004), From bedside to boardroom—Nursing shared governance, Online journal of issues in nursing 9(1):2
 Medeiros, M. (2018), Shared governance councils: 10 essential actions for nurse leaders, Nursing Management,
Volume :49 Number 7 , page 12 – 13
 Swihart, D. (2011), Shared Governance: A Practical Approach to Transform Professional Nursing Practice, Second
Edition 2nd Edition
 Note: these slides is uploaded for information purposes and as partial requirement of Philippine Women's University in PhD
class; Subject: Governance in Health Care Practice