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  1. Underwood, Carlisa M. DNP, RN
  2. Hayne, Arlene N. PhD, RN


OBJECTIVE: The purpose was to identify and describe structures and processes of best practices for system-level shared governance in healthcare systems.


BACKGROUND: Currently, more than 64.6% of US community hospitals are part of a system. System chief nurse executives (SCNEs) are challenged to establish leadership structures and processes that effectively and efficiently disseminate best practices for patients and staff across complex organizations, geographically dispersed locations, and populations.


METHODS: Eleven US healthcare SCNEs from the American Nurses Credentialing Center's repository of Magnet(R)-designated facilities participated in a 35-multiquestion interview based on Kanter's Theory of Organizational Empowerment.


RESULTS: Most SCNEs reported the presence of more than 50% of the empowerment structures and processes in system-level shared governance.


CONCLUSIONS: Despite the difficulties and complexities of growing health systems, SCNEs have replicated empowerment characteristics of hospital shared governance structures and processes at the system level.