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Boost Nurse Responsibility with Shared Governance

 |  By  
   May 31, 2011

Developing a shared governance structure can empower direct care nurses to make decisions about their practice and take more responsibility. Nurse leaders take note: It has been shown to increase retention and employee satisfaction, improve safety and patient satisfaction, reduce lengths of stay, and result in a more robust bottom line.

Every nurse wants to work in an organization that has a healthy work environment, where team members work collaboratively and collegially, and where nurses make decisions about the way nursing care is practiced, delivered, and measured for continuous improvement.

Ensuring such an environment is simpler if organizations adopt a formal shared governance structure that empowers direct care nurses—and other healthcare workers—to be involved in decision making around patient care in all practice settings.

Diana Swihart, PhD, DMin, MSN, CS, RN-BC, a regional nurse at the Denver Office of Clinical Consultation and Compliance, Veterans Health Administration, is an expert on shared governance, and has designed a shared governance structure for a number of growing multi-facility healthcare systems as part of their journeys to excellence and American Nurse Credentialing Center (ANCC) Magnet Recognition Program® designation.

The model of shared governance engages shared decision-making to result in  shared leadership based on the principles of partnership, equity, accountability, and ownership at the point of service.

This infrastructure can provide safe, effective, and efficient patient care necessary to facilitate nursing excellence at all levels of practice.

“It empowers all members of the healthcare workforce to have a voice in decision making,” says Swihart. “It makes every employee feel like he or she is part owner with a personal stake in the success of the organization. This level of engagement leads to longevity of employment, increased employee satisfaction, better safety and healthcare, greater patient satisfaction and shorter lengths of stay, and a more robust bottom line for the organization.”

Developing a shared governance structure can empower direct care nurses to make decisions about their practice rather than following those handed down or mandated from above. It brings nurses back into alignment with their interprofessional partners, physicians, and pharmacists, and also promotes safer, more effective patient care.

“Employees who are happy and feel respected in their jobs take greater responsibility for their decisions and are more vested in organizational and patient care outcomes,” says Swihart. “Everyone benefits from shared governance.”

The ANCC recognizes the inherent, transformational value of shared governance and has made it a key determinant for any organization seeking ANCC Magnet Recognition Program® designation.

But getting to a true and functional system of shared governance is tricky. Many organizations start down the road only to find difficulties in identifying exactly what shared governance should look like in their organizations, what it entails to implement, and how to achieve the final result.

Organizations may also be hampered by transactional leaders who are unwilling or unable to release any control, hesitant, experienced nurses who do not trust the initiative is genuine, or by concerned direct-care nurses fearful of yet another change that will pull them or their peers away from patient care.

If organizations are willing to invest resources and time and commit to establish and sustain a culture of shared governance, these problems can be resolved equitably.

Swihart identifies four elements that are essential to the successful implementation of shared governance in the earliest stages of process development:

1.      A committed nurse executive who is invested in nurse empowerment and willing to undertake the efforts and energy necessary to implement shared governance

2.      A strong management team that is committed to each other, to nursing, to the organization, and to building the structure and implementing the processes

3.      Employees who receive continuing education and professional development so they understand shared governance and can build a working knowledge of what is to be accomplished and how to do it

4.      A clear destination, with a strategic plan and timeline for implementation

To change an organization’s culture and implement shared governance, leadership needs a design team that involves members from nursing service and interprofessional and interdisciplinary teams. The design team will do three things:

  1. Obtain feedback from leadership and staff
  2. Consider nursing’s objectives and the organization’s goals, mission, and philosophy
  3. Draft a model for operationalizing shared governance

After the design team has done its work, the final design should be selected by nursing staff and nursing leadership to ensure there is an integrated structure and process for shared decision making with an end goal of positive patient care outcomes and shared leadership. The structure and processes are designed to address each accountability element for professional nurses: quality, competence, and practice.


Rebecca Hendren is a senior managing editor at HCPro, Inc. in Danvers, MA. She edits and manages The Leaders' Lounge blog for nurse managers. Email her at

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