Shared governance, or a more current descriptor, professional governance, is a critical component of our discipline. As legendary nurse leader Dr. Tim Porter-O'Grady, DM, EdD, APRN, FAAN, FACCWS, writes in this month's feature “Principles for Sustaining Shared/Professional Governance in Nursing,” we've been struggling with it for over 35 years. Why do we have inconsistency with this key to engagement, accountability, and professional practice? It's the start of a new year full of promise and hope—let's vow to commit to professional governance moving forward.
Why should you care? To start, it's a ubiquitous concept imbedded in the discipline of nursing and a mandate for a profession. I found 174,000 Google Scholar results for “nursing shared governance.” There's an interesting pair of Journal of Nursing Administration editorials from 2017 by Dr. Porter-O'Grady and Dr. Robert Hess on the evolution of shared governance to professional governance. But please don't get hung up on the terms. The bottom line is the empirical evidence on value, outcomes, engagement, communication, professional development, job satisfaction, and more.
There's the expectation of professional governance fixed in Healthy Work Environment models and Magnet® and Pathway to Excellence® standards, with requirements for structured empowerment and shared decision-making. There's no question of the significance and importance of professional governance to nursing's control over our own practice and giving a voice to clinical nurses.
Maybe your next question is: What exactly is it? In every organization, including those in which you've worked, there's probably a different structure, with varying levels of independence and oversight. The continuum from no structure/hierarchical dependence to meaningful structure/true professional governance is long and varied. Generally, some structures are decentralized to the unit level whereas others are centralized functionally. Evolved models may be interprofessional, large healthcare systems may address practice from a mixed model, and so on. You can find many articles and books on the different models. Where does your department and organization stand?
The main point besides professional accountability is that this journey is one of partnership. Of course, there are boundaries to professional governance within organizations and even based on pure logical management, particularly as it relates to operations. However, nurses can't be subordinate (a word I usually despise when used by leaders) or subject to top-down mandates when it comes to ownership of practice. A good example of professional practice ownership is quality reviews. Are your cases peer-reviewed? Think about it; they should be.
I share a love of Millennials with Dr. Porter-O'Grady. They're our future and will lead the way. I see their expectation for ownership of professional governance every day and their desire to make a difference. I'm not ignoring you Gen X leaders; I respect you as well, and I'm simply making the point that we must embrace and engage our Millennial nurses at the beginning of their careers.
Nursing Management starts a new Shared Governance Spotlight department this year based on the interest of our readers. We hope to be a resource for you as you travel along the governance continuum and lead your teams to engaged decision-making, autonomy, ownership of and accountability for practice, and quality. I often write about our obligations as nurse leaders, and this is clearly another important one. We have a responsibility for exemplary practice, governed by the discipline, in partnership with our organizations. Let's bring in the new year with the voices of all nurses loud and clear.