Whether you've been asked to start a council on your unit or you want to refresh an existing council, there are proven actions for nurse leaders to develop and support shared governance councils. A successful shared governance model poses a paradigm shift for both leaders and staff, which may cause discomfort as nurses learn new skills to enhance empowerment and excellence. The principles of partnership, equity, empowerment, accountability, ownership, and support are inherent for shared governance to be effective at the unit and organizational levels. Remember that only 10% of unit-level decisions should be made by management.1 This actualization of point-of-care decision-making is essential in shared governance and often allows leaders and staff members to embrace characteristics of each other's roles.
For nurse managers to be successful in leading empowered organizations and council members to be effective in improving practice, they must understand the concepts of responsibility, authority, and accountability. Responsibility is clear and specific allocation of duties to achieve desired results, authority is the right to make decisions, and accountability is reflecting on actions/decisions and evaluating their effectiveness.1 Council members need to accept responsibility, understand where their authority lies, and be accountable for the decisions that they have the authority to make.
With that brief overview, here are 10 essential actions for nurse leaders to put into practice.
1. Be clear about what shared governance is
Shared governance is a venue for clinical staff members to have a voice in decisions regarding practice and the practice environment. It has been defined as "a model that allows for decentralized decision-making, increased ownership and accountability in nursing practice, and empowerment within an organization."2 It means that the people at the point of service are involved in problem solving and action planning to create better ways of providing care.
2. Help staff members understand why shared governance is important
Staff members may worry that shared governance will mean more work for them and the payoff won't be worth it. If your team has a unit practice council that's gotten off track, redefining the council's purpose can help. As members rotate on and off the council, often the purpose and focus become distorted or lost. A skilled leader can get the team back on track.
3. Orient council chairpersons on the basics of planning and running meetings
Once councils are formed, staff chairpersons need education on how to run a meeting, plan an agenda, keep meaningful minutes, set goals, and more. Having regularly scheduled education sessions for the unit council chairpersons and cochairpersons is essential for making councils successful.
4. Cultivate a sense of ownership
In shared governance, staff members take ownership of their unit's outcomes. Through participation in their unit or department council, they have an opportunity to make a difference for patients. They'll analyze outcome data, set goals, and develop action plans to improve clinical, department, and organizational outcomes.
5. Encourage a continuous focus on mission and vision
When you begin designing or improving a unit practice council, it's a great time to review the organization's mission, vision, and strategic priorities. Make the connection for staff members between the work they're doing and the strategic vision of the organization. They should realize that what they do not only affects patient outcomes, but also the success of the whole organization.
6. Provide council members with protected time to meet
Staff members will need protected time away from regular work to focus on shared governance. Time and again, we hear how difficult it is to get staff members off the unit. Providing protected time means having a plan on council days for coverage of patient care so staff members can get to meetings or have the option of joining via phone or videoconference to participate from home.
7. Include staff in council development or redesign
If there are staff members on your unit who are versed in the principles and value of shared governance, include them in council planning and implementation, or council revival, to enhance the engagement of others. Involve staff members early; not only will they engage others in the process, but they'll also have great ideas on how to make it work.
8. Coach and mentor chairpersons
Ongoing support from leaders in planning meetings, analyzing data, leadership-building skills, and expectations is needed for councils to be successful. Council chairpersons and cochairpersons can be groomed to be future leaders. Whether as a chairperson or a member, participating in a unit practice council is an amazing way to develop professionally, enhance leadership skills, and learn about the unit and the organization.
9. Recognize excellence
Nurse managers support unit councils by recognizing team members involved in shared governance. If a staff member leads the council well and/or if a council's work improves an outcome, recognition is appropriate and encouraged. A year-end celebration of all councils in the organization, with each council reporting on accomplishments and improvements made during the last year, is one method to recognize their work. Sharing positive results is an effective way to highlight the work of shared governance councils and enhance collegiality between councils.
10. Study the successes (and struggles) of others
Shared governance success stories aren't hard to find. One article highlights the ways in which shared governance has been brought to life, with stellar results, at SSM Health St Mary's in Madison, Wis.3 The authors note that the experiences common to shared governance shape future leaders. Another article looks at how staff members at Baptist Hospital East in Louisville, Ky., shared, through town hall meetings, their vision and commitment to participate in department decision-making and, by extension, the whole organization, as they planned and implemented shared governance.4 Outcomes noted as a direct result of shared governance include falls reduction, congestive heart failure readmission rate reduction, increased RN satisfaction, safe lifting and handling, and other organizational outcomes.4 Looking at the successes and struggles of those who've gone before has brought us lessons such as the need for tools and resources to be made available to facilitate council work and ensure that boundaries and roles are clear to all who participate in shared governance.
Positive outcomes in the making
Offering guidance around what shared governance is, what it's intended to accomplish, and how to participate in it effectively goes a long way to engage staff members and help them see the value. Nurse leaders are instrumental in council success by providing needed support and skills, and empowering teams to make decisions that lead to improvements in patient care, clinical outcomes, and staff satisfaction.
REFERENCES
1. Guanci G. Feel the Pull. Minneapolis, MN: Creative Health Care Management, Inc.; 2016. [Context Link]
2. Robert N, Finlayson S. Fundamentals of Magnet(R) Toolkit. Silver Spring, MD: American Nurses Association; 2015. [Context Link]
3. Beglinger JE, Hauge B, Krause S, Ziebarth L. Shaping future nurse leaders through shared governance. Nurs Clin North Am. 2011;46(1):129-135. [Context Link]
4. Newman KP. Transforming organizational culture through nursing shared governance. Nurs Clin North Am. 2011;46(1):45-58. [Context Link]
RESOURCES
American Organization of Nurse Executives. Nurse manager competencies. http://www.aone.org/resources/nurse-manager-competencies.pdf.
Haag-Heitman B, George V. Guide for Establishing Shared Governance: A Starter's Toolkit. Silver Spring, MD: American Nurses Credentialing Center; 2010.
Malloch K, Porter-O'Grady T. The Quantum Leader: Applications for the New World of Work. 2nd ed. Burlington, MA: Jones & Bartlett Learning; 2008.
Porter-O'Grady T, Malloch K. Quantum Leadership: Creating Sustainable Value in Health Care. 5th ed. Burlington, MA: Jones and Bartlett Learning; 2018.
Swihart D. Shared Governance: A Practical Approach to Reshaping Professional Nursing Practice. Marbelhead, MA: HCPro, Inc.; 2006.