1. Medeiros, Marky MSN, RN

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The benefits of shared governance have been cited in the literature for many years, including stronger staff ownership of data and outcomes, such as patient experience and healthy work environments.1 Shared governance allows managers and staff to come together in the decision-making process. Involving nurses in organizational decisions is a demonstrated way to improve staff satisfaction and retention. In one research article, staff and leaders acknowledged that giving nurses a voice improved nurse satisfaction.2 When asked what they valued about being involved in decision-making, both staff and leaders identified the empowering qualities of confidence, respect, and belonging to a team.2

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As we reflect on how involvement in the decision-making process makes us feel like part of the team, we can see the importance of shared governance to successfully meeting organizational strategic priorities and goals. Empowering those closest to the work to make decisions regarding the work inspires ownership and is a driving factor in improving outcomes. Especially when improving outcomes is the focus of shared governance council work.


Although shared governance often begins with nurses developing and implementing the structure, many organizations embrace the involvement of interprofessional partners and ancillary departments in decision-making regarding patient care and its complex facets. It makes sense that better quality decisions can be made when all stakeholders have input into the decisions that affect patient care and the care environment. For example, at Pennsylvania Hospital, a gap was identified related to improving the patient experience, pointing to the need to engage nursing ancillary staff in the process to improve the gap.3 They developed a nursing ancillary staff shared governance council that functions collaboratively within the nursing shared governance structure.3 As a result, there's been a decrease in nursing ancillary staff turnover.3 In addition, the nursing ancillary staff shared governance council set a goal to improve Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores specifically related to the responsiveness domain.3 The council aligned with the hospital-wide initiative to improve HCAHPS scores and identified the impact they could make, particularly because nursing ancillary staff members are often the first to respond to patient calls.3


One cross-sectional observational study used secondary data sources to examine the differences in nurse engagement in shared governance across hospitals to determine the relationship between nurse engagement and patient and staff outcomes.4 The study concluded that hospitals with shared governance are more likely to have better patient, staff, and quality outcomes.4 This suggests that there's a business case for the involvement of nurses in institutional decision-making as a strategy to improve patient experience, staff retention, and quality and safety.


An organization that initially attained Magnet(R) recognition but was unable to successfully attain redesignation learned the value of effective shared governance and how important it is to keep structures and processes in place that support staff voices in decision-making. After a restructure and revitalization of their shared governance model, and much attention to not only staff voices, but also engagement and ownership of data, this organization was able to reinvigorate shared governance and regain Magnet recognition. This example highlights the importance of keeping momentum with shared governance to engage staff and achieve excellence.


With increasing efforts, guidelines, regulations, and mandates emerging for healthcare organizations to improve patient and staff outcomes, the time is now for us to apply proven strategies, structures, and processes. Shared governance is one effective strategy to that end. Let's dedicate this year's Shared Governance Spotlight department to sharing our innovative ideas and discussing our positive outcomes that are a result of shared governance and our commitment to council work. As we move into the new year and set goals to improve ourselves, our teams, and our organizations, let's take the time to celebrate the successful work we've done to increase the well-being of our patients and our colleagues.




1. Guanci G, Medeiros M. Shared Governance That Works. Minneapolis, MN: Creative Health Care Management; 2018. [Context Link]


2. Graham-Dickerson P, Houser J, Thomas E, et al The value of staff nurse involvement in decision making. J Nurs Adm. 2013;43(5):286-292. [Context Link]


3. Reich J, Ruggiero J, Triantos L. Engaging nursing ancillary staff through shared governance. Nurse Lead. 2018;16(4):224-228. [Context Link]


4. Kutney-Lee A, Germack H, Hatfield L, et al Nurse engagement in shared governance and patient and nurse outcomes. J Nurs Adm. 2016;46(11):605-612. [Context Link]