Use the principles of shared governance to create an environment that empowers nurses to practice at their full potential and supports their professional development.
Editor's note: This article is an excerpt from HCPro's book Essential Skills for Nurse Managers.
For nurse managers who genuinely want to develop the staff reporting to them, who intend to foster a sense of partnership rather than a parent/child relationship, and who know that collaboration across disciplines improves patient care, shared governance offers a way to “walk the talk.”
Shared governance provides the infrastructure for decentralizing decision-making. It offers a process that allows professional nursing staff and managers to contribute collectively to decision-making about patient care, nursing practice, and the work environment—all of which culminate in shared leadership. Shared decision-making and shared leadership are two other terms often used in conjunction with shared governance, which was first described in nursing literature in the mid-1980s by Dr. Tim Porter O’Grady.
Over the last 30 plus years, the shared governance model for fostering professional nursing practice has been implemented in several thousand hospitals to varying degrees of success.
When the implementation process loses momentum, or the sustainability of the structure is called into question, managers need to know how to diagnose and deal with the issues. This knowledge is crucial not only from the perspective of the monetary investment but also from the damage done to morale when staff nurses realize they have shared governance in name only.
As a nurse leader, when you face issues that threaten to undermine your shared governance journey, it is imperative to talk about the “elephant in the room” by acknowledging when mistakes have been made, so that you can learn from them. In fact, this is the only way to navigate the years-long journey to create a professional work environment and move decision-making to the point of service, which is exactly where it belongs.
Typical Miscues, Pitfalls, and Impediments
The process of implementing shared decision-making is hard work, requiring time and persistence. Our heritage as a profession comes from the military and the church, so hierarchy is second nature to us. As a result, top-down decision-making, parent/child ways of relating, and functioning as an oppressed group at the lower level of the hierarchy are strong culture norms.
Evidence of this hierarchical norm plays out in typical patterns seen in healthcare organizations across the country. These patterns waste time and energy and may even derail the shared governance process altogether. Review the following list of common issues and see whether you recognize any of them from your own experience:
- Confusing participative management with shared decision-making
- Misusing the coordinating council
- Failing to notice the need for linkage
- Giving lip service—real decisions still made by management
- Training seen as a cost rather than as an investment
- Nurse managers reluctant to relinquish control
What if My Organization Does Not Have Shared Governance?
As a nurse manager in a facility, department, or organization without the structure for shared decision-making, you can still use many of the concepts and accomplish some of the same goals by setting the tone of partnership with the staff with whom you work. Consider any or all of the following ideas to get started:
- Have the staff identify who they want to serve on a staff action team—five, seven, or nine is the ideal size. When the staff tell you who they want on the team, they are more likely to cooperate with the decisions made by the team.
- Ask the staff to identify four or five issues they want to see the staff action team work on, and have the team report on their progress in staff meetings.
- Provide training and resources for the staff action team so that they feel increasingly able to make good decisions and have the information and support they need to deal with substantive issues.
- Develop team agreements with the staff so that they know what you expect and you know what they expect of you. By doing this, you are acknowledging your support for their decisions about clinical practice issues.
- Be as transparent as possible about the “why” behind decisions or policies, not just the “what” that needs to happen.
- Identify the skills and talents you can see in the staff and find ways to help them develop these talents. For example, use evidence-based practice as a learning curve for staff who enjoy patient care or research.
- Routinely celebrate successes and learn from mistakes so that you create a culture of learning from mistakes and fixing the system rather than affixing the blame.
- Involve staff in opportunities for problem solving and process improvement such as Lean daily management and cross-functional groups to build horizontal relationships.
- Tap into the experience of staff nurses who may have worked in a shared governance structure before coming to your organization.
Using the Four Guiding Principles
When you consider the four guiding principles of shared governance, it is easy to see why this is as much a way of being as it is a model for decision-making:
- Partnership: Everyone has a voice—collaborative relationship between all stakeholders
- Equity: No one is more important than another, and everyone has a role to play
- Accountability: Embedded in professional practice and the core of shared governance
- Ownership: Willingness to answer for results and learn from mistakes
Keep these principles in the forefront of all that you do as a nurse manager, and they will serve you well. If you create an environment that empowers nurses to practice at their full potential, ensures autonomy of practice, depends on point of service decisions, supports professional development, and advances clinical practice, you have an environment in which any of us would want to work.
The full book, Essential Skills for Nurse Managers, is available in the HCPro store.
Sharon Cox, DNP, RN, MSN, is a consultant and founder of Cox & Associates.
Shared governance allows nursing staff and managers to contribute to decision-making about patient care, nursing practice, and the work environment.
Shared decision-making principles can be used in organizations that don't have shared governance.