Often times, registered nurses can find the discrepancy between their responsibility for their own nursing practice and the decision-making process at leadership and management levels frustrating.
This is how the idea of shared governance first developed more than 30 years ago. This conflict, which pits nurses' control of their own nursing practice against their place in healthcare organizations, is at the heart of the movement to improve shared governance in nursing.
Traditionally, the nursing profession has been viewed as a female-dominated occupation. As such, certain concepts of shared governance, such as control over practice and ownership of actions, weren't validated like they were in other male-dominated professions (e.g., law or engineering). But now efforts to improve decision-making and enhance collaboration among staff nurses and nurse leaders are paving the way for greater autonomy and management of healthcare delivery.
Why is shared governance in healthcare important?
Shared governance in healthcare plays an important role in direct patient care and employee engagement. Systems of shared governance, which may vary from one facility to the next, according to institutional values and goals, help promote professional practice environments while empowering nurses to help make decisions affecting themselves, their colleagues, and their patients.
Research indicates healthcare organizations that promote employee engagement outperform other facilities in several areas, such as:
- Job satisfaction
- Nurse retention
- Performance, including better patient care experiences
- Profitability
In fact, participation in shared decision-making has shown to be so important that hospitals seeking Magnet status must demonstrate effective structures of shared governance.
How can you promote shared governance in health organizations?
There's no one right way to promote shared governance within your organization. Your facility's needs are different from other healthcare centers, and your direct care nurses have different opinions and issues that must be addressed.
Taking these specific issues into account, you must set ground rules for shared governance in your facility. Setting strong foundations for shared governance can make or break the process. It doesn't do any good if the decisions of staff nurses are constantly overridden by nurse managers. And while some direct care nurses won't want to be part of decision-making, others will jump at the opportunity to make their voices heard.
Determining the nurses' preferred level of involvement in decision-making is a good first step toward developing your organization's shared governance model. Once you've done that, here are some examples of shared governance in nursing you can try:
Unit councils
Organized and implemented by direct care nurses, unit councils offer staff nurses on the floor the chance to share their opinions, suggest ways to improve the patient care experience, and make decisions regarding process improvements.
Hospital councils
During these sessions, nurses from many units to come together to discuss issues affecting nursing practice and patient care throughout the entire organization. Members of nursing leadership should be present to support staff nurses in their decision-making and act as intermediaries between the staff and upper management.
Themed councils
Some organizations host themed nursing councils that address broader issues such as quality and safety, professional development or the healing environment.
Your leadership style also makes a difference
The way you approach leadership also makes a difference in the success of shared governance. Transformational leadership facilitates working with direct care nurses to determine areas of change and solutions for that change. In general, four characteristics help to define transformational leadership:
1. Idealized influence
Nurse leaders serve as role models for direct care nurses, embodying the qualities of a professional clinician.
2. Inspirational motivation
The ability to inspire and motivate direct care nurses through the presentation of your vision for change.
3. Individualized consideration
This is true concern for your nurses' needs and feelings. This component helps you develop trust among nursing staff while helping them to self-actualize.
4. Intellectual stimulation
You challenge other nurses to be creative in challenging the status quo. You help your nurses achieve higher levels of performance with your support and encouragement.
Used together, these components of transformational leadership and steps to share in decision-making among staff will help promote and implement a shared governance model inside your healthcare organization.
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