1. Section Editor(s): Thomas, Sarah Beth MSN, RN, CCRN, CNRN, SCRN

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As healthcare facilities across the country meet the halfway point of their fiscal year, staff are busy evaluating plans and outcomes, analyzing data, and discussing programs and interventions. At this time, healthcare leaders should also address the need for greater involvement from direct caregivers at the bedside in higher-level decision-making.

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As we close the fiscal year, many different top-down approaches-town hall meetings, hospital-wide communication blasts, and the constant multiplication of unit-level staff meetings-will rear their ugly heads. We have all sat through our share of endless staff meetings and been barraged by email requests, but how often do we pause to consider the current culture of patient care and safety at our facilities?


A seismic shift is occurring in the general landscape of hospital administration and leadership, and its name is shared governance. Although not a new concept-shared governance has been around since the mid-1970s-this leadership model has recently risen in popularity. As one of the pioneers of shared governance in the early 21st century, Tim Porter O'Grady identifies it as a structured process in which a nurse can raise his or her level of professional autonomy. In doing so, a nurse grows his or her level of partnership, equity, and accountability for practice-related decisions with the individuals who will operationalize the final decision.


In a 1910 speech about citizenship in a republic, Theodore Roosevelt conceded, "It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better. The credit belongs to the man who is actually in the arena." These words support the invaluable contribution that frontline critical care nursing staff can make when determining new hospital policies and procedures using evidence-based practices.


In these changing times, it is important that nursing leadership realizes we are healthcare professionals first and our primary duty is to our patients. Whether directly or indirectly, patient care relies on our ability to make sound judgments. For hospital administrators to better understand the challenges that frontline critical care nurses face, we must be involved in the quality improvement and decision-making process from the very beginning. When the creativity and ingenuity of the nursing workforce is leveraged by hospital management, positive change will be more effective, long-lasting, and more easily accepted by frontline staff.


Sarah Beth Thomas, MSN, RN, CCRN, CNRN, SCRN

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Professional Development Manager, Neurosciences Center Brigham and Women's Hospital, Boston, Mass.