Introduction
Nursing profession is committed to provide quality
health care to the clients. Nurses are responsible
and accountable for their specialised practice. The
concept of shared governance in nursing is a mechanism
for healthcare organisations to empower clinical nurses
to participate in decision-making that affects nursing
practice within an organisation.
Shared
governance gives clinical nurses’ control over
their practice and can extend their influence into
administrative areas that are controlled only by managers.
Shared governance structures are comprehensive and
complete. In designing a shared governance structure
utmost importance must be given to meet the demands
of both groups by enhancing cost effective patient
care.
Shared
Governance in Nursing
Shared governance in nursing is a managerial innovation
that legitimises nurses’ control over practice,
while extending their influence into administrative
areas previously controlled only by managers (Hess,
1998).
Shared governance is necessary to cultivate a professional
practice environment for the nurses. Without it, organisations
lack innovative,
The author is Officiating Professor, Manipal College
of Nursing, Manipal. |
effective
way to minimise nurse turnover, improve clinical decision-making,
and support the autonomous environment necessary to
meet the expectations. Transferring authority
for clinical decision making to professional nurses
who have adequate management knowledge and expertise
will open avenues for managers to have a strong operational
authority.
In
shared governance in nursing, the primary resources
for practice are the providers themselves. Therefore,
to control practice, nurses must have influence over
themselves as a professional group.
Key
Concepts in Shared Governance Structures
1.
Beliefs about people
 Nurses are
good and worthy of trust
Professional
nurses are self-governing
Individual
needs must be recognised and valued
Professional
nurses expect partnerships and participation
Professional
nursing judgment is essentially for quality care.
2.
Leadership expectations
The top nursing leader must be:
Charismatic
and motivating
Teachers
Facilitators
of nursing practice
Leaders
in all arena of practice |
Transformational.
3.
Work place values
A priority
for well-defined nursing roles and accountabilities
Pre-eminence
of professionally defined relationships between nurses
and others
Respect
for collaboration with professional groups
Value for
the multi-disciplinary nature of patient care
Support
for decision making at the point of service
Priority
for efficient communication
Importance
of equal participation
Respect
for strategic information sharing
Value for
all disciplines.
Goal
of Shared Governance: The goal is to get more
nurses involved in their work and profession and to
strengthen nursing in the workplace in ways that would
empower nursing as a profession and retain the interest
of individual members (Porter O’ Grady, 2003).
Principles
of Shared Governance: Shared governance is
neither a form of participatory management nor management
driven.
It has no locus of control. Models should be based on
a clinical rather than an administrative organisation.
Governance should be representative in nature. Further,
the representatives should be elected, not selected.
Bylaws should provide a system of checks and balances, |
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and should be passed by majority vote of the entire
nursing staff.
Models
of Shared Governance
The
Councilor model: It is the most frequently
implemented model and is based on the decentralisation
of professional accountability and an appropriate locus
of control. It can be implemented at the departmental
and unit levels. The model includes 5 areas of accountability
i.e. Practice, Quality improvement, Education, Research
and Management.
For
each area of accountability a council (decision making
body) is formed within the department of nursing with
defined powers and accountabilities. Typically, four
councils are clinical in nature and fifth is a management
council. A majority of practicing staff nurses are members
of the clinical councils with a management representative
acting as an advisor.
The
Management council, which includes the chief nursing
officer, nursing service directors, nurse managers,
and staff nurses, is chaired by a nurse manager. The
manager’s role will move from motivation to empowerment.
The
Administrative model : It splits the organisational
chart into two tracks with either a management or clinical
focus. The membership in both tracks often encompasses
both managers and staff as implementation progresses.
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The
Congressional model: It relies on a democratic
component to empower nurses to vote on issues as a group.
Whichever model is used for the implementation of shared
governance, the ultimate emphasis must be on the transfer
of legitimate authority for decision making to the nursing
staff.
There may be initial difficulties, since it requires
a lot of practice, understanding and commitment, but
the rewards and benefits outweigh the difficulties.
Research
Evidence
Research studies have shown that shared governance in
nursing is beneficial and very effective in improving
nurses’ decision making skills and improving patient
care services and outcomes. Some of the benefits reported
in various studies related to shared governance are
as follows:
Greater
control over decisions affecting practice: A 2003
study found that the highest staff nurse ownership of
practice issues and outcomes occurred where there were
visible, viable, and recognised structures devoted to
nursing control over practice.
Ability
to exercise control over personnel : A 1998 study
validated the Index of Professional Nursing Governance
(IPNG) as a measure of governance and identified that
the most important factor in differentiating shared
governance |
hospitals
from traditional organisations were nurses’ ability
to exercise control over personnel in areas such as
hiring, transferring, promoting, and firing personnel;
performance appraisals and disciplinary actions; salaries
and benefits; and the creation of new positions. Other
significant area was nurses’ involvement in staffing,
supplies, and budgets.
Increased
autonomy, authority and accountability: A 1992
study identified the benefits of using a quality assurance
council in shared governance as a method to increase
nurse autonomy, authority and accountability.
Improvement
in work environment: A 1993 study concluded that
improvement in decision making style of managers, professional
job satisfaction, and organisational job satisfaction
and anticipated turnover was present when shared governance
was implemented.
A
1994 study reported a perceived increase in autonomy,
communication, decision making and team sense when shared
governance was implemented on one intensive care unit
Nurses
satisfaction: A 2001 multisite ex post facto co
relational study found that nurses working on shared
governance units had a more positive composite constructive
culture, higher job satisfaction that reflected greater
satisfaction with work, professional status, cohesion
and administration but lower retention rate than traditional
units.
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Disadvantages
Efficiency
will be limited because it lengthens the time required
to complete critical processes such as planning and
assessment.
Quality
of decisions will be affected by opinions from members
not adequately qualified to speak on the issues.
The nurse
managers may have additional responsibility as they
may have to serve as mentors to staff nurses who have
no previous experience in decision making.
Makes nursing
care a secondary responsibility as some staff nurses
become more interested and involved in decision making
rather
than their patient care assignments.
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May result
in an unfavourable amount of power, control and advantage
to certain staff nurses.
Conclusion
Shared governance serves as a vehicle for change, growth
and empowerment for the profession and the professionals
and builds sound collaborative interdisciplinary relationships
for future health care delivery.
The
Shared Governance Councillor model integrates the nursing
core values and philosophy of nursing into the council
structure to achieve excellence in patient care.
Shared
Governance promotes nursing professional growth through
the principles of partnership, ownership, leadership
and accountability. By implementing shared governance
strategies specific channels of communication can be
used to
resolve
conflicts within individual organisational settings
and nurses can be prepared adequately to deal effectively
with conflicts arising around patient care and physician-related
issues.
References
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