Definition/Introduction

The critical concept of nursing shared governance is shared decision making between the bedside nurses and nurse leaders, which includes areas such as resources, nursing research/evidence-based practice projects, new equipment purchases, and staffing.[1] This type of shared process allows for active engagement throughout the healthcare team to promote positive patient outcomes and also creates a culture of positivity and inclusion, which benefits job satisfaction. 

Nursing Shared Governance is a pillar of the ANCC Magnet culture. Utilizing this approach in the hospital setting allows for better nurse satisfaction and improved patient outcomes. The process of building this type of structure and the related processes can be challenging among both nurse administrators and bedside nurses. Open communication and collaboration among team members are the best practices for overcoming these and other potential barriers.[2] Shared governance shifts the focus from a top-down management style to a collaborative focus from the administrative team to the nurses providing care at the bedside. 

A healthcare organization wishing to develop and implement a shared governance program should spend time in the literature identifying potential areas of vulnerability and known pitfall areas. Conducting a thorough self-assessment will lead to smoother planning, implementation, and evaluation of the new program. Omitting this step can lead to the issues discussed below, among others. 

Issues of Concern

Achieving bedside nurse buy-in can be a challenging process when approaching shared governance. The increased level of work and time commitment associated with beginning a shared governance structure adds to the difficulty of receiving buy-in from bedside nurses.[3] Most bedside nurses are working 12-hour shifts while balancing their home life responsibilities, and some are working on furthering their formal education. All these components challenge the ability and desire to add more to their already full plates. These nurses must see the “why” for shared governance clearly to buy in fully. 

Involving the nurses who work off shifts such as nights and weekends can provide and organization with concern. Reaching this population requires planning and diligence to meet their needs and expectations. A dedicated plan with follow-through is necessary to facilitate the involvement of these off shift nurses. Some ideas to achieve this would be to offer shared governance council meetings on nights and weekends, scheduling meetings during these off shifts every few months, and seeking out volunteers to be the advocate in reaching this group of nurses. 

Nursing leadership must take time to provide education about the process, bring bedside nurses to the table from the start, and instill trust. Training is necessary to build a foundational knowledge of what shared governance is and how it will benefit the nursing staff and patients within the healthcare system. Having these nurses participate from the beginning will help build confidence in the process and assist with buy-in. Nurses participating also helps to begin the trust-building sooner, which will give the bedside nurses a greater sense of confidence and ownership of the shared governance structure.[3] 

Robust processes and procedures to support growth are vital to the success of any new program, but this is especially true of shared governance. Following the PDSA improvement cycle will assist an organization with developing sustainable policies and procedures during the shared governance planning, implementation, and evaluation stages. Tracking and monitoring are vital components to achieving and sustaining success.[4] 

Clinical Significance

Improved patient outcomes are the most significant clinical impacts associated with a nursing shared governance structure within healthcare organizations. Numerous studies have found improved results for nursing-sensitive indicators such as catheter-associated urinary tract infections, hospital-acquired pressure ulcers, falls with injuries, and central line-associated bloodstream infections using shared governance structures and processes. Knowledge of this benefit should aid in the desire for all nurses to be involved in this type of initiative.[5] 

Improved job satisfaction among nurses is also a positive clinical impact for those implementing a shared governance structure. Nurses are more engaged in policy development and revision, helping to give them a better overall picture of the hospital environment. Nurses are also more satisfied when they see their ideas at work within the various patient care improvement projects. Giving the nurse a sense of belonging and loyalty to their healthcare organizations also increases morale and performance.[5] 

Successfully shared governance programs and structures assist healthcare organizations with internal succession planning. Bedside nurses become actively engaged with decision making, policies, and procedures, which helps them to see their leadership skills come to life. Nurses move from being members to the chairperson of the shared governance councils. Active learning occurs during this participatory process. Growth internally of nursing leaders helps healthcare organizations promote from within, improve the culture through career ladder plans, and allows for investing in the future of the organization.[6] 

Nursing, Allied Health, and Interprofessional Team Interventions

Communication among bedside nurses and nursing leadership is a critical area for successfully implementing a healthy, shared governance structure. Frequent check-ins and clarification meetings may need to take place early during the planning phase. Communication allows for addressing concerns and suggestions first and consensus to occur through each step of the process. Clear and consistent communication is necessary within the healthcare setting for promoting collegiality, patient safety, and building trust.[7] 

Interprofessional involvement enhances a healthcare organization’s shared governance structure. This type of collaboration brings all healthcare providers to the table to make positive and meaningful changes to policies, procedures, and projects. This collaborative focus again impacts patient outcomes among providers. An interprofessional shared governance structure is more complicated than one who is nursing centric. Bringing together these many disciplines requires great care and planning, with the Performance Improvement Committee being an ideal hub to form this process.[8] 

Nursing, Allied Health, and Interprofessional Team Monitoring

Completing pulse checks to determine the current state of the shared governance structure is key to success and continued improvement and evolution. Numerous avenues for quantitative assessment of shared governance structures exist, including the National Database of Nursing Sensitive Quality Indicators (NDNQI) database, the Practice Environment Scale of the Nursing Work Index (PES-NWI), and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) to name a few.[8][5] These assessments, among others, will allow for a comprehensive overview of the successes of the shared governance structure and provide the needed data to support continued evaluation and performance improvement planning.