Definition/Introduction

The critical concept of nursing shared governance is shared decision-making between the bedside nurses and nurse leaders, including resources, nursing research and evidence-based practice projects, new equipment purchases, and staffing.[1] This shared process allows for active engagement throughout the healthcare team to promote positive patient outcomes. It also creates a culture of positivity and inclusion, which benefits job satisfaction. 

Nursing Shared Governance is a pillar of the American Nurses Credentialing Center (ANCC) Magnet Recognition Program culture. Utilizing this approach in the hospital setting improves nurse satisfaction and patient outcomes. Building this structure and the related processes can be challenging for nurse administrators and bedside nurses. Open communication and collaboration among team members are the best practices for overcoming these and other potential barriers.[2] Shared governance shifts the focus from a top-down management style to a collaborative focus from the administrative team to the nurses providing care at the bedside. 

A healthcare organization wishing to develop and implement a shared governance program should spend time in the literature identifying potential areas of vulnerability and known pitfall areas. Conducting a thorough self-assessment leads to smoother planning, implementation, and evaluation of the new program. Omitting this step can lead to the issues discussed below, among others. 

Issues of Concern

Achieving bedside nurse buy-in can be a challenging process when approaching shared governance. The increased 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 work 12-hour shifts while balancing their home-life responsibilities, and some are working on furthering their formal education. All these components challenge the ability and desire to add more to their already full plates. These nurses must see the "why" for shared governance to buy in fully. 

Involving the nurses who work off shifts such as nights and weekends can provide an 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 shared governance council meetings on nights and weekends, schedule meetings during these off shifts every few months, and seek out volunteers to advocate for reaching this group of nurses. 

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 a foundational knowledge of shared governance and how it benefits the nursing staff and patients within the healthcare system. Having these nurses participate from the beginning helps build confidence in the process and assists with buy-in. Nurses' participation also helps to begin trust-building sooner, giving the bedside nurses greater 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 Plan-Do-Study-Act (PDSA) improvement cycle assists an organization with developing sustainable policies and procedures during the shared governance planning, implementation, and evaluation stages. Tracking and monitoring are vital components to achieving and sustaining success.[4] 

Clinical Significance

Improved patient outcomes are the most significant clinical impacts of a nursing-shared governance structure within healthcare organizations. Using shared governance structures and processes, numerous studies have found enhanced results for nursing-sensitive indicators such as catheter-associated urinary tract infections, hospital-acquired pressure ulcers, falls with injuries, and central line-associated bloodstream infections. Knowledge of this benefit should aid in the desire for all nurses to be involved in this initiative.[5] 

Improved job satisfaction among nurses also has a positive clinical impact on those 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 nurses a sense of belonging and loyalty to their healthcare organizations also increases morale and performance.[5] 

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 see their leadership skills come to life. Nurses move from being members to the chairperson of the shared governance councils. Active learning occurs during this participatory process. Internal growth of nursing leaders helps healthcare organizations promote from within, improve the culture through career ladder plans, and allow for investing in the organization's future.[6] 

Nursing, Allied Health, and Interprofessional Team Interventions

Communication among bedside nurses and nursing leadership is critical for successfully implementing a healthy, shared governance structure. Frequent check-ins and clarification meetings may need to take place early during the planning phase. Communication allows for first addressing concerns and suggestions and consensus to occur through each process step. Clear and consistent communication is necessary in healthcare to promote collegiality, patient safety, and building trust.[7] 

Interprofessional involvement enhances a healthcare organization’s shared governance structure. This collaboration brings all healthcare providers to the table to make positive and meaningful changes to policies, procedures, and projects. This collaborative focus again impacts patient outcomes among providers. An interprofessional shared governance structure is more complicated than one that is nursing-centric. Bringing together these many disciplines requires great care and planning, with the Performance Improvement Committee being an ideal hub to form this process.[8] 

Nursing, Allied Health, and Interprofessional Team Monitoring

Completing pulse checks to determine the current state of the shared governance structure is key to success and continued improvement and evolution. Numerous avenues for quantitative assessment of shared governance structures exist, including the National Database of Nursing Sensitive Quality Indicators (NDNQI) database, the Practice Environment Scale of the Nursing Work Index (PES-NWI), and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) to name a few.[5][8][5] These assessments, among others, allows for a comprehensive overview of the successes of the shared governance structure and provide the needed data to support continued evaluation and performance improvement planning.