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The benefits of shared governance

Lockhart, Lisa MHA, MSN, RN, NE-BC

doi: 10.1097/01.NME.0000585088.35054.df
Department: Ask an Expert
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Lisa Lockhart is the Director of Nursing Services at Saint Joseph East in Lexington, Ky., and a Nursing made Incredibly Easy! Editorial Board Member.

The author has disclosed no financial relationships related to this article.

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Q: I know nursing shared governance can take on many different forms, both formal and informal, but what exactly is shared governance and why's it important?

A: Dr. Tim Porter-O'Grady defines shared governance, now often referred to as professional governance, as “a professional practice model, founded on the cornerstone principles of partnership, equity, accountability, and ownership that form a culturally sensitive and empowering framework, enabling sustainable and accountability-based decisions to support an interdisciplinary design for excellent patient care.” What a powerful way to define this vital component of just culture, empowerment, and engagement within the nursing workforce. The goal is to improve safety, quality, and collaboration while increasing work satisfaction. This requires a paradigm shift in perceived power and actual decision-making.

Shared governance is designed to integrate nursing's core value system and belief model into practice, taking nursing from the point of care to the executive level in a unified effort to improve care quality. This concept alters the traditional model of top-down governance under which most organizations previously operated. The idea that employees at the point of care are the single most valuable organizational asset began in the mid-1960s. By the late 1980s and early 1990s, the value system of autonomy, involvement, and empowerment was at the forefront of practice and advocated for as not only a means to drive care, but also to recruit and retain engaged employees.

Within these descriptors, multiple variations exist for how shared governance is managed by individual organizations. The most popular framework utilizes the council model of care management, which allows nurse-run councils to develop and orchestrate nursing practice. Management's role in this model is typically supportive and facilitative, with point-of-care practitioners guiding and directing practice. Typically, the councils consist of evidence-based practice, clinical practice, recruitment and retention, and unit-based councils, and there's usually a governing council that integrates the structure at an administrative level.

The congress model is another framework for shared governance that's developed by a central collaboration of members from across the organization who meet as one council, with room for breakout sessions and variations in structure. Research has shown similar satisfaction with this model as compared with the council model.

Whether in one large committee or several smaller councils, an integral component of shared governance is communication. Administrators, managers, and employees must engage in a give-and-take about where they are, where they need to be, and how to jointly get there. This brings the idea of shared governance as not just a nursing practice model, but an organizational practice model into focus.

The foundation of shared governance is based on collaboration and communication at all levels, along all service lines. Think of it as shared leadership. This transformation of culture and practice further empowers multidisciplinary teamwork to positively affect care quality and promote excellent outcomes.

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REFERENCES

Anthony MK. Shared governance models: the theory, practice, and evidence. Online J Issues Nurs. 2004;9(1):7.
Hess RG Jr. From bedside to boardroom—nursing shared governance. Online J Issues Nurs. 2004;9(1):2.
Vanderbilt University. Shared governance. https://ww2.mc.vanderbilt.edu/shared governance.
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