1. Lockhart, Lisa MHA, MSN, RN, NE-BC

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Q: What's shared governance?

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A: Shared governance is a model of nursing practice that's designed to integrate nursing's core value system and belief model to drive quality care. In simpler terms, shared governance takes nursing from the point of care to the executive level in a unified effort and integrated mission to improve care. This concept alters the traditional model of top-down governance that most organizations previously used.


The most popular form of shared governance is the council model of care management. Magnet(R) hospitals often utilize nurse-run councils to develop and orchestrate nursing practice for the organization. Management's role in this model is typically supportive and facilitative. This allows the point-of-care practitioner to guide and direct practice. The council structure usually consists of evidence-based practice, clinical practice, recruitment and retention, and unit-based councils, in addition to a governing council at the administrative level.


Research has shown that employing the council model positively affects the organization in several ways, such as increased staff satisfaction scores, improved care quality and patient satisfaction, better staffing ratios, and an affirmative change in management and decision-making styles.


One study researched the effect of shared governance on the work environment, including work load, empowerment, engagement, innovation, and employee satisfaction. Nurses in the study were asked to convey their attitudes about these areas before and after a shared governance model was instituted. The results were positive by a significant margin. There's a lack of research available to definitively state which model of shared governance is the most beneficial, but variations do exist in how the practice model is integrated within the organizational hierarchy. This variation has a significant effect on satisfaction.


Although positive, the shared governance committee structure is cumbersome to maintain. It's important to remember that these committees are vehicles to promote interaction and communication. The committee structure allows for management and staff to participate in joint decision making.


A large component of shared governance is communication-the idea that managers, administrators, and employees don't simply "talk" but rather participate in a give and take about where they are, where they need to be, and how to jointly get there. For this reason, shared governance isn't just a nursing practice model, but also an organizational practice model. The core of shared governance is collaboration and communication at all levels, along all service lines. Doesn't this qualify then as shared leadership?


When you survey the literature, the focus on shared governance appears to be more of a shared organizational leadership model. This evolution of culture and practice further empowers cooperation and multidisciplinary teamwork to affect care quality and promote positive patient outcomes.




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