This document discusses shared governance in nursing. It begins by outlining shared governance and defining it as a model of participatory decision making for nurses. It then discusses the history and benefits of shared governance, including better nurse engagement, job satisfaction, and patient outcomes. Some drawbacks are increased workload and potential conflicts. Common shared governance models are described along with their key principles such as ownership, accountability, and autonomy. The document concludes by providing steps to implement shared governance such as establishing councils and communication guidelines.

1. PHDN605 GOVERNANCE IN HEALTH CARE PRACTICE
PHDN-K SY2022-2023 2nd Trimester
Reporter: Shaolin Chen /2022t0834
Shared governance in nursing

2. Outline
the outline of shared governance in nursing
Benefits and drawbacks Of Shared Governance In Nursing
Nursing Shared Governance models
Main Principles Of Shared Governance In Nursing
How to implement shared governance in nursing？

3. What Is Shared Governance In Nursing?
Shared governance in nursing is an environment where professional nurses have the
legitimate authority to make decisions about practice, standards, policies, and procedures.
It is a working model characterized by participatory decision-making in which nurses and
other interdisciplinary team members follow organized decision-making processes regarding
quality improvement, practice standards, professional development, and research.
Tim Porter-O'Grady, a shared governance pioneer, defines shared governance as "a structural
model through which nurses can express and manage their practice with a higher level of
professional autonomy.”

4. What Is Shared Governance In Nursing?
Shared Governance is:
A leadership model
A tenant of professional practice
Open communication between all staff members
A way to promote staff engagement
An expression of an organizational culture

5. The History Of Shared Governance In Nursing?
Shared governance in nursing was originally introduced in the 1970s and 1980s. However, its
popularity waxed and waned for a brief period.
Nursing shared governance was popularized in 1985 with the publication of Shared
Governance for Nursing: A Creative Approach to Professional Accountability, which Porter-
O'Grady co-authored.
Today, shared governance is considered the most preferred leadership model by
transformational leaders in nursing and throughout healthcare.

6. Benefits Of Shared Governance In Nursing
1. Better Nurse Engagement: Engaged nurses working together to achieve a common goal
positively impact patients, nursing and interdisciplinary teams, and the organizations they work
with.
2. Increased Efficiency: it allows healthcare administrators to optimize the efficiency of
healthcare services.
3. Improved Patient Outcomes
4. Increased Job Satisfaction: it creates opportunities for nurses to see their ideas in action
within their work environment. This makes nurses feel like their knowledge and skills are
valued and appreciated, thereby increasing job satisfaction and their sense of belonging.

7. Benefits Of Shared Governance In Nursing
5. Increased Nurse Retention: When nurses feel satisfaction and a sense of belonging, they
often feel a greater sense of loyalty to their employer or organization.
6. Better Interdisciplinary Relationships: it allows nurses to network with peers and supports
collaboration among nursing units, facility departments, and healthcare team members,which
lead to better relationships between nurses and other interdisciplinary team members.
7. Better Patient Satisfaction Scores: When committees or councils work together with facility
staff to implement measures based on shared decision-making and solid, evidence-based
practices, patient outcomes improve, resulting in better patient satisfaction scores.
8. Lower Healthcare Costs: it tends to have lower rates of spikes in healthcare costs. It may be
attributed to the fact that shared governance considers ideas from teams who develop and
implement measures to promote high-quality, more cost-effective care.

8. Benefits Of Shared Governance In Nursing
9. Staff Members’ Professional Growth is a Plus for Their Organizations: Participation in
shared governance involves active learning. As nurses learn and grow, they can move from
being members of a council to chairperson, and employee growth means they can promote from
within the company.
10. It is the Cornerstone for Magnet Accreditation: Magnet status is the highest credential
nursing facilities in the United States and worldwide can obtain. Work environment, nursing
excellence, quality patient outcomes, and innovations in nursing practice are considered.
Another fundamental requirement of medical facilities applying for Magnet status is
demonstrating an effective model of shared governance.

9. Drawbacks Of Shared Governance In Nursing
1. Shared governance in nursing often requires an increased level of work and greater time
commitment, making it a less attractive option for bedside nurses who already work long hours.
2. In matters of nursing education, one drawback of nursing shared governance occurs when faculty
committee members disagree about methods of research and classroom instruction. In some cases, one
faculty member may desire to utilize strategies that others feel are inappropriate or controversial. In
these instances, the shared governance model would allow the majority to stop the faculty member
from implementing his preferred strategies.
3. Despite the many benefits of shared governance, it is not uncommon for some members of shared
governance councils or committees to become inactive, creating internal imbalance and conflicts.
When this occurs, the committee's goals may be delayed, or poor outcomes may result.

10. Nursing Shared Governance models
1:Summa’s Nursing Shared Governance Model has unit-based clinical practice councils that discuss
and resolve nursing practice and process issues that affect the unit.
The Nursing Leadership Council, Nursing Recruitment and Retention Council, and Nursing Research
Council provide forums for discussion and communication of strategies to promote shared governance
or review research studies to enhance practice.
Practice issues affecting multiple units go to the Nurse Practice Councils for further discussion and
resolution. The Nursing Cabinet (nursing leadership group) is at the center of the model providing
support to all Councils.

11. Nursing Shared Governance models
2.Brigham and Women’s Faulkner Hospital Shared governance model: Shared governance is a process
that promotes shared decision-making at the point of care. Empowered nurses have a voice in matters
involving their professional practice and day-to-day operations on the unit. They believe that providing
excellent patient care involves a collaborative team environment.
Our shared governance structure includes valuable members of the interdisciplinary healthcare team.
The key components to successful shared governance model involve teamwork, problem-solving and
accountability. The ultimate goal of our shared governance structure is to ensure quality patient
outcomes as well as improved staff and patient satisfaction.

12. Nursing Shared Governance models
3.nursing professional practice model
It is a schematic that symbolizes our beliefs, values, theories and systems for nursing practice. The
Maury Regional Medical Center (MRMC) Model for Nursing Professional Practice is our unique
depiction of all the key components of nursing practice at MRMC.
The center of the model shows the hospital’s focus on person-centered care. This validates nursing’s
commitment in supporting the hospital mission of serving our region with world class care (Excellence
in Action). Each of the colored ribbons on the right and left side illustrate structures, processes and
outcomes used in the delivery of care..

13. Nursing Shared Governance models
3.nursing professional practice model

14. Main Principles Of Shared Governance In Nursing
Shared governance in nursing is characterized by eight main principles: ownership, accountability
empowerment, teamwork, leadership, innovation, practice equity, and autonomy. The following are
brief descriptions of the principles of shared governance.
1.Ownership: Everyone involved in shared governance must commit to investing in the process of
shared governance and accept responsibility for their own contributions. In shared governance, instead
of nurses referring to "their patient" or "their assignment," the natural progression of the shared
governance requires nurses to translate those phrases into "their practice."
2.Accountability: Accountability is a willingness to take ownership of one's practice decisions that
support partnerships that improve patient and organizational outcomes. Accountability is supported by
an outcome-based review, implementation of proper actions within each practice role, and provision of
a collaborative environment that fosters and supports teamwork.

15. Main Principles Of Shared Governance In Nursing
3.Empowerment: Empowerment refers to access to resources and appropriate psychological responses
to those resources. It is defined as the autonomy and authority to influence or make decisions about
clinical practice.
4.Teamwork: Teamwork is the fundamental building block of interprofessional decision-making. Each
nurse has a role in supporting and actively engaging in efforts to meet the vision, values, and mission
of the healthcare organization's plan.
5.Leadership qualities: Leadership qualities are the outcome of active participation within the nursing
shared governance models. When employers offer leadership training, resources, and tools combined
with mentorship, it creates an environment conducive to developing advanced leadership skills and
qualities.

16. Main Principles Of Shared Governance In Nursing
6.Innovation: Innovation is associated with a spirit of inquiry. Having a mind of innovation leads to
higher levels of evidence-based practice and promotes research investigation, which positively impacts
patient outcomes.
7.Practice Equity: Practice Equity ensures that all members of the patient care team realize their
contributions are valuable and necessary to drive positive patient outcomes. Equity and equality in
terms of knowledge, responsibility, authority, and scope of practice are not the same. However,
practice equity acknowledges that each team member plays an essential role in providing effective,
safe patient care and that their contributions are necessary.
8.Autonomy: Autonomy is referred to as self-governance. It is the nurse's ability to influence practice
and their workplace. Nurses must understand that autonomy is not possible without equity and a
balanced environment. Action planning through shared governance in nursing councils enhances
autonomy by giving nurses the responsibility and authority to make decisions about their practice.

17. Main Principles Of Shared Governance In Nursing
6.Innovation: Innovation is associated with a spirit of inquiry. Having a mind of innovation leads to
higher levels of evidence-based practice and promotes research investigation, which positively impacts
patient outcomes.
7.Practice Equity: Practice Equity ensures that all members of the patient care team realize their
contributions are valuable and necessary to drive positive patient outcomes. Equity and equality in
terms of knowledge, responsibility, authority, and scope of practice are not the same. However,
practice equity acknowledges that each team member plays an essential role in providing effective,
safe patient care and that their contributions are necessary.
8.Autonomy: Autonomy is referred to as self-governance. It is the nurse's ability to influence practice
and their workplace. Nurses must understand that autonomy is not possible without equity and a
balanced environment. Action planning through shared governance in nursing councils enhances
autonomy by giving nurses the responsibility and authority to make decisions about their practice.

18. HOW TO IMPLEMENT SHARED GOVERNANCE IN NURSING?
The following are 10 steps involved in successfully implementing shared governance in nursing.
1. Establish a Steering Committee: The steering committee should represent nurses from all clinical
areas and nursing roles. Diversity among committee members helps to ensure the perspectives of
nurses from all levels are represented.
2. Determine Criteria for Accepting Volunteer Memberships: Each council should have membership
criteria to ensure invitations are extended to those most appropriate to fill the membership role.
3. Elect or Appoint Chair and Co-Chairs: Although the goal of shared governance in nursing is to
have a team approach to decision-making. Once a committee is established, facility administrators
may opt to appoint a chair and co-chairs or allow the committee members to vote.
4. Develop Councils: Some organizations ask for staff nurse volunteers, while others choose to hold
an election to determine council members. s.

19. HOW TO IMPLEMENT SHARED GOVERNANCE IN NURSING?
5. Create a Mission Statement: Each committee member makes suggestions for what should be
included in the mission statement; then, the committee-appointed or elected chair and co-chairs create
a final draft for approval by members.
6. Establish Bylaws: Bylaws for shared governance should include determining the maximum
number of members, meeting schedule and cadence, term limits for members, plans for member
turnover, and a written policy of confidentiality and open communication. Additionally, the bylaws
should include guidelines for bringing issues to the council for consideration.
7. Educate Nurses in All Clinical Areas About the Shared Governance Model and Their Role: Once
the type of nursing shared governance model is determined, nurses in the relevant clinical area should
be educated about the purpose of the model and their role in implementing shared governance.

20. HOW TO IMPLEMENT SHARED GOVERNANCE IN NURSING?
8. Establish Guidelines for Bringing Issues of Concern Before the Council for Consideration: As with
any successful organization or committee, there should be clear guidelines for how issues are
presented to the council, the anticipated timeframe for having the issue addressed, and how decisions
will be made announced.
9. Establish a Preferred Method of Communication for Staff of All Levels of the Organizations:
Depending on the type of organization where shared governance is implemented, committee or
council members may work alternating shifts or opposite shifts from one another. Establishing a
preferred method of communication allows team members to know the expectations for
communication and what to anticipate regarding responses to communication.
10. Determine a Timeline for Implementation: Establishing protocol and implementing measures to
promote shared governance in nursing requires work. Timelines may differ depending on your
organization's nursing culture and its willingness to accept change. It is essential to set reasonable
timelines which allow for appropriate planning and implementation to ensure success.

21. examples for Shared Governance In Nursing
 Emergency Department Needs Additional Space for Patient Overflow
 Scenario: Emergency room nurses at St. Mary's Hospital voice concerns about
overcrowding and compromised patient privacy due to a lack of space to handle an
increase in the number of patients.
 Implementing Shared Governance: Emergency department nurses and nurse leaders
meet and discuss measures to improve workflow in the ER and options for opening
unused areas of the hospital near the emergency room for ER needs. For example, some
nurses suggest using a smaller wing close to the emergency room for intake and triage.
Other nurses feel rearranging the set-up in the open area of the department could create
space for more beds and equipment, including adding more privacy curtains between
patient stations.

22. examples for Shared Governance In Nursing
 Lack of Shared Governance: Without input from emergency room nurses, the
seriousness of the depth of need may not be as clear. The nurses who work in the
emergency department experience the effects of overcrowding and lack of space to
perform care firsthand. While nursing administration may desire to improve the
situation, a lack of shared governance to address the issues may cause oversight and
prevent resolution.
 Benefits of Implementing Shared Governance: By using nursing shared governance,
nurses and nurse leaders can discuss the impact of overcrowding in the emergency
department. Once everyone expresses their concerns, the team can offer suggestions for
eliminating the problem, creating an atmosphere conducive to improved patient privacy,
easier access to equipment, improved patient outcomes, and employee satisfaction.

23. Thanks for your attention!
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