This document discusses shared governance in nursing. It defines shared governance as a nursing practice model that engages frontline nurses in leading practice excellence through principles like ownership, accountability, and empowerment. Implementing shared governance requires a clear vision and framework. Benefits include improved patient and financial outcomes through nurse-driven changes. Challenges to implementation include gaining nurse buy-in due to increased time commitments. Success requires education, trust-building, and robust processes like PDSA cycles.

1. Shared Governance

2. Background
What is shared governance and why is it
important? What role does shared
governance play in our practice? How do we
apply best practices within the shared
governance framework? These are
questions often pondered by nursing teams.
Buzzwords like “shared governance,”
“interdisciplinary teams,” and
“multidisciplinary collaboration” are often

3. Background
used in discussions. These words can imply
that integrating a shared governance model
framework will automatically lead to
improved collaboration and employees will
become more engaged in the workplace.
However, lacking a clear vision of a
workable shared governance model, many
organizations may struggle with not only
implementation, but also integration and

4. Background
sustainability of this process as well.
Conversely, a thoughtful shared governance
model will often result in a robust
interdisciplinary team with clinical nurses
driving changes over time.

5. Concept
Governance is defined as
1.The act or process of governing or
overseeing the control and direction of
something such as a country or an
organization
2.In nursing -good governance is
establishing effective health systems,
empowerment,

6. Concept
engagement,autonomy, critical
thinking,based on bestpractices
3.The shared governance structure is a
nursing practice model which is a hallmark
of engaging the front line team into the role
of leading practice excellence. The main
principles of shared governance include
ownership, accountability, empowerment,
team building, leadership, innovation,

7. Concept
autonomy, and practice equity. Combining
these key shared governance principles with
formal models can drive sustainable action
planning for improvement.

8. Theory
1.Governance can range from direct patient
care decisions to decisions in managing
work environment (Burnhope and
Endmonstone2003;Hess,1995)
2.Evidence suggests an improvedfinancia
picture after implementing shared
governance.Cost savings and cost
reductions.

9. Theory
3.Shared governance targets decision-
making across types of decisions.This is
moving from the hierarchal structure to the
councilorstructure.
4.Committee structure resulted in overall
hours spent in meetings,but the meeting
hours per full time is dropped.

10. History
Governance dates back from the time of
exemplary nurse leaders .Nurse leaders
established best practices using their
passion for nursing.Had a purpose in the
nursing profession and were all from
different backgrounds and different
situations in life.Were able to break barriers
leading to changes in nursing and in society.
Used their passion,skills, and leadership

11. Theory
abilities to coordinate care,supervise care,
and lead by example.Brought about good
outcomes in healthcare specifically nursing.

12. Clinical Significance
1.Improved patient outcomes are the most
significant clinical impacts associated with a
nursing shared governance structure within
healthcare organizations.Numerous studies
have found improved results for nursing-
sensitive indicators such as catheter-
associated urinary tract infections, hospital-
acquired pressure ulcers, falls with injuries,
and central line-associated bloodstream

13. Clinical Significance
infections using shared governance
structures and processes. Knowledge of this
benefit should aid in the desire for all nurses
to be involved in this type of
initiative.Knowledge of this benefit should
aid in the desire for all nurses to be involved
in this type of initiative.
2.Improved job satisfaction among nurses is
also a positive clinical impact for those

14. Clinical Significance
implementing a shared governance structure.
Nurses are more engaged in policy
development and revision, helping to give
them a better overall picture of the hospital
environment. Nurses are also more satisfied
when they see their ideas at work within the
various patient care improvement projects.
Giving the nurse a sense of belonging and
loyalty to their healthcare organizations also

15. Clinical Significance
increases morale and performance.
3.Successfully shared governance programs
and structures assist healthcare
organizations with internal succession
planning. Bedside nurses become actively
engaged with decision making, policies, and
procedures, which helps them to see their
leadership skills come to life. Nurses move
from being members to the chairperson of

16. Clinical Significance
the shared governance councils. Active
learning occurs during this participatory
process. Growth internally of nursing leaders
helps healthcare organizations promote from
within, improve the culture through career
ladder plans, and allows for investing in the
future of the organization.

17. Issues of Concern
Achieving bedside nurse buy-in can be a
challenging process when approaching
shared governance. The increased level of
work and time commitment associated with
beginning a shared governance structure
adds to the difficulty of receiving buy-in from
bedside nurses.[3] Most bedside nurses are
working 12-hour shifts while balancing their
home life responsibilities, and some are

18. Issues of Concern
working on furthering their formal education.
All these components challenge the ability
and desire to add more to their already full
plates.

19. Technology
1.Involving the nurses who work off shifts
such as nights and weekends can provide
and organization with concern. Reaching
this population requires planning and
diligence to meet their needs and
expectations. A dedicated plan with follow-
through is necessary to facilitate the
involvement of these off shift nurses. Some
ideas to achieve this would be to offer

20. Technology
shared governance council meetings on
nights and weekends, scheduling meetings
during these off shifts every few months, and
seeking out volunteers to be the advocate in
reaching this group of nurses.
2.Nursing leadership must take time to
provide education about the process, bring
bedside nurses to the table from the start,
and instill trust.Training is necessary to build

21. Technology
a foundational knowledge of what shared
governance is and how it will benefit the
nursing staff and patients within the
healthcare system. Having these nurses
participate from the beginning will help build
confidence in the process and assist with
buy-in. Nurses participating also helps to
begin the trust-building sooner, which will
give the bedside nurses a greater sense of

22. Technology
confidence and ownership of the shared
governance structure.
3.Robust processes and procedures to
support growth are vital to the success of
any new program, but this is especially true
of shared governance. Following the PDSA
improvement cycle will assist an
organization with developing sustainable
policies and procedures during the shared

23. Technology
governance planning, implementation, and
evaluation stages. Tracking and monitoring
are vital components to achieving and
sustaining success.

24. Research
Increasing Quality and Patient
Outcomes with Staff
Engagement and Shared
Governance(Deborah Brennan,
DNP, RN, RNC-OB, NE-BC Lori
Wendt, BSN, RN)

25. Process
The discussion of shared governance in this
article describes the process at a suburban
community hospital with approximately 200
beds. The hospital employs about 550
clinical registered nurses (RNs). There are
over 30 RNs who serve on the hospital
shared governance council. Our structure
includes more than a dozen unit level
councils that represent areas such as

26. Process
medical-surgical care, critical care, and
community outreach. These smaller unit
councils typically include 6-12 nurses per
council and include other disciplines and
roles in attendance.
We completed a gap analysis and the initial
outcomes suggested changes such as an
updated meeting cadence and template for
the meetings; adopting a formalized “Plan,

27. Process
Do, Check, Act” (PDCA) action plan; and
integrating additional improvements (Ghosh,
2012). The PDCA cycle provided a
sequential step by step process to evaluate,
analyze, strategize, set goals, plan, and
appraise effectiveness. These steps
facilitated greater engagement and
understanding about the improvement
process, and led to the productive and

28. Process
meaningful outcomes described in examples
below. We also included an evaluation of the
council process; meeting format and content;
impact and outcomes.

29. Conclusion
1.The shared governance structure is a
nursing practice model which is a hallmark
of engaging the front line team into the role
of leading practice excellence. The shared
governance process is based upon the
ideas of partnership, equity, accountability,
and ownership . These foundational aspects
of shared governance are key elements for

30. Conclusion
success . These core aspects were a part of
our ability to align shared governance
decision-making with the A3 action planning
format, the PDCA cycle, and LEAN
methodologies to support a more robust
nurse-driven process that used structured,
data driven analysis and ownership at the
organizational and unit level.

31. Conclusion
2.The team shared that they felt able to
focus on hospital and unit specific goals and
work with the new process as they sought
greater autonomy over their practice. The
nursing leadership team and the chief
nursing officer fully supported the work and
process. This support was pivotal to the
successful implementation of the process
and outcomes. Inclusion of others on an

32. Conclusion
interdisciplinary team was also pivotal to
success. The partnership with a
collaborative team decreased barriers and
facilitated improved engagement,
participation, and outcomes success.

33. Thank
you