Shared Governance: Empowering and Creating Competent and Committed Nurses
- 1. Shared Governance: Empowering and Creating Competent and Committed Nurses Connie R. Vendicacion, RN, MAN
- 2. Disclosure The author of this presentation disclosed no relevant relationships with any commercial organization to influence the content of this learning material.
- 3. Learning Outcomes At the end of this presentation, the readers will be able to: Define Shared Governance and Shared Governance in Nursing. Identify the principles of shared governance, its advantages and disadvantages. Understand the implementation of shared governance in a nursing organization.
- 4. Introduction “Good leaders make people feel that they’re at the very heart of things, not at the periphery. Everyone feels that he or she makes a difference to the success of the organization. When that happens, people feel centered and that gives their work meaning” - Warren G. Bennis
- 5. What is Shared Governance? It is a shared decision-making based on the principles of partnership, equity, accountability and ownership at the point of service. It involves empowerment of all members of the healthcare workforce to have a voice in decision-making, which encourages diverse and creative input that will help advance the business and healthcare missions of the organization. In this type of management process model, the employee feels like he/she is a “part manager” who has a personal stake in the organization's success
- 6. Shared Governance in Nursing Nurse Leaders Bedside Nurses Shared Decision-Making Resources Nursing Research Evidence-Based Practice Projects Equipment Staffing
- 7. Shared Governance in Nursing It is a pillar of the ANCC Magnet culture. This encourages active engagement among the members of the healthcare team to promote positive patient outcomes. It creates a culture of positivity and active involvement that leads to staff’s satisfaction. It shifts the governance from a top- down management style to a collaborative focus from the administration to the nurses who are providing direct patient care at the bedside.
- 8. History of Shared Governance In 470 – 399 B.C., Socrates integrated shared governance concepts in his education philosophies. The Socratic Method lets the teacher facilitate the student’s autonomous learning and the students are encouraged to use reason instead of making an appeal to authority. In 1863, the US government model was established on the concepts of shared governance, wherein the citizens are directly responsible for the government on both state and federal levels. As what Abraham Lincoln said in his Gettysburg Address in 1863, “of the people, for the people, for the people” Shared Governance eventually found its way into business and management as organizations start to create formal structures and relationships among leaders and employees. In 1970s – 1980s, as part of participative management, shared governance found its way in healthcare and nursing due to nurses’ dissatisfaction from the institutions.
- 9. Contributing Factors Towards Shared Governance In the era of organizational theories, Herzberg (1966) and McGregor (1960) considered employees as the most important asset of an organization, hence, must invest in their motivation and growth. This lead to advocacy of autonomy, empowerment, involvement and participation. (Bolman and Deal, 1997) In 1986, Deming introduced the concepts of quality management and proposed that organizations value quality and must empower workers to be more productive and emphasized the importance of leadership and team building. Kanter’s Theory on structural power suggest that formal and informal power give access to work empowerment structures which include opportunity, resources, support and information. In nursing, shared governance was introduced to improve nurses’ work environment, satisfaction and staff retention.
- 10. In the increasing complexity of nurses’ struggle in patient care delivery, workplace partnership between nurses and employing organizations is vital for the successful delivery of healthcare. Shared governance provides organizational support for nurses who provide direct patient care and enables them to become committed to quality nursing practice. It empowers both workers and workplaces and has been linked to nursing job satisfaction, quality care and fiscal viability. Shared decision-making works best in a in decentralized structure wherein staff at the point of service make their own decisions and determine whether they are appropriate (Koloroutis, 2004) Why is there a need for Nursing Shared Governance?
- 11. Essential Actions Towards Shared Governance 1. Be clear about what shared governance is. 2. Assist and guide staff members understand the importance of shared governance. 3. Give orientation to council chairpersons about the basics of planning and facilitating meetings. 4. Cultivate a sense of ownership. 5. Encourage a continuous focus on mission and vision. 6. Council members must be provided with protected time to conduct meetings. 7. Involve staff in council development or redesign 8. Coach and mentor chairpersons. 9. Recognize excellence. 10.Study the successes and struggles of others
- 12. Principles of Shared Governance Partnership Equity Accountability Ownership
- 13. Partnership This is vital in building relationships, as all staff members are involved in decision-making and other processes. It emphasizes that each member plays a key role in fulfilling the organization’s purpose and mission, which is critical to the healthcare system’s effectiveness (Porter-O’Grady and Hinshaw 2005; Batson 2004)
- 14. Equity This principle maintains a focus on services, patients and staff and is the foundation of measure and value. It emphasizes that “no one role is more important that any other”; each team member is essential to providing safe and effective care. (Porter-O’Grady and Hinshaw 2005; Batson 2004; Porter-O’Grady, Hawkins and Parker 1997)
- 15. Accountability The core of shared governance that supports partnership. It is the willingness to invest in making decisions and demonstrate ownership in those decisions. This term is often used interchangeably with responsibility. (Porter-O’Grady and Hinshaw 2005; Batson 2004)
- 16. Accountability vs. Responsibility Accountability Responsibility Defined by outcomes Defined by functions Self-described Delegated Embedded in roles Dictated by specific tasks/routines Partnership-dependent Isolative Evaluation is shared Supervisor evaluation Contributions-driven value Tasks-driven value Adapted from T. Porter-O’Grady and K.S. Hinshaw, 2005
- 17. Ownership Shared governance requires staff members to have commitment in contributing something, to own what they contribute and to participate in devising purposes for the work. (Porter-O’Grady and Hinshaw 2005; Batson 2004; Koloroutis 2004; Page 2004)
- 18. Governance Models The Whole-Systems Governance It creates a transitional model for ownership across all levels of the organization. Accountability is also reflected at each level and creates a seamless structure directed towards he delivery of health service to its community. The nurses’ role in whole-systems governance is multifaceted, occurring within the multiple levels of the organization. This model emphasizes that all employees have their roles in the organization, participating as part of the organization in the directions, policies, decisions and objectives that set the future of an organization.
- 19. Governance Models Nurse-Shared Governance The critical concept of this type of governance is shared decision-making between the nurse leaders and bedside nurses. This type of governance promotes collaboration and open communication among the administrative leaders and bedside nurses. Although it promotes nurse satisfaction and positive patient outcomes, the process of building this type of governance and the related processes can be challenging for both leaders and frontline nurses.
- 20. Governance Models Professional-Shared Governance It focuses on the creation of a structural framework that is consistent with different professions. Professional governance distinguishes itself from management functions with its exclusive control over the profession’s own practice. It works as a partner with the organizations instead of being controlled or managed by them. Professional shared governance brings every professional stakeholder to the table to create a team, having the focus of realizing goals, enhancing professionalism and improving the delivery of services.
- 21. Advantages of Shared Governance Improved patient outcomes Improved job satisfaction Promotes sense of belongingness and loyalty to staff and also increases morale and performance Increased engagement among staff members Decreased staff turnover It assists succession planning for organizations Lower burnout rates Improved nurse-physician relationships
- 22. Disadvantages of Shared Governance Inefficient – consultation with members and consideration of alternatives requires a lot of time and it also considerably lengthens implementation of policies. Divisive – discussions may create diverse idea that may lead to conflicts Undercuts privacy and secrecy – issues amongst personnel and negotiation about policies may be prematurely revealed during discussions Chaotic – unexpected issues that may alter plans and procedures can arise at anytime Arbitrary – everyone cannot be included all the time. Sometimes, debates need to end to make a decision, that could make other members feel left out or ignored.
- 23. Implementation of Shared Governance The implementation may take at least 3-5 years because of the extended preparation period necessary for both management and staff for each phase of the process. There is a remarkable relocation of decision making in shared governance and the nurse executive must be comfortable with this in order to be successful. Both nursing and general administrative leadership must be committed to the anticipated changes. According to Wilson (1989), there must be a consensus about the meaning of shared governance because each position in the organization will experience a different role change.
- 24. Implementation of Shared Governance A steering committee which includes staff and management must be available to oversee the process of shared governance. The philosophy and purpose of the organization must be determined, specific and applicable to the department. It may focus on development of nurse-patient relationship, nursing’s participation in supporting the goal and how the work will be organized to support the practice environment and standards for evaluation of results. It must be emphasized that shared governance will not happen without management support, so they must be present at the implementation process.
- 25. Implementation of Shared Governance A decision-making group must be established, commonly called a unit- based council, wherein chairpersons and members must be selected who will serve as the decision-making body group. Education and training must be provided to all council members regarding their new roles and responsibilities. A timetable must be established to ensure efficiency and to monitor progress.
- 26. “The best executive is the one who has sense enough to pick good men to do what he wants done, and self-restraint to keep them from meddling with them while they do it”. - Theodore Roosevelt
- 27. References: McKnight H. and Moore S. (2019). Nursing shared governance. StatPearls. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK549862/ Hess, R. (2004). From bedside to boardroom – nursing shared governance. The Online Journal for Issues in Nursing. Retrieved from http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume92004/No1Jan04/FromBedsidetoBoa rdroom.html VijayaNarayanan, R. (2014). Shared governance: reality or sham? In nursing profession. International Journal of Nursing Care, 2(1), 32-26. Retrieved from https://search.proquest.com/docview/1515962943/fulltext/B746FA8CF99B43BFPQ/8?accountid=38643 History and development of shared governance. (2019). Nurse Leader Insider. Retrieved from http://www.hcpro.com/NRS-266847-975/From-the- staff-development-bookshelf-History-and-development-of-shared-governance.html Green, A. and Jordan, C. (2004). Common denominators: shared governance and workplace advocacy – strategies for nurses to gain control over their practice. Online Journal of Issues in Nursing, Vol. 9, No. 1, Manuscript 6. Retrieved from http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume92004/No1Jan04/SharedGoverna nceandWorkPlaceAdvocacy.html Anthony, M. (2004). Shared governance models: the theory, practice and evidence. The Online Journal of Issues in Nursing. Retrieved from https://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume92004/No1Jan04/SharedGovern anceModels.aspx#:~:text=Shared%20governance%20is%20a%20model,environment%2C%20satisfaction%2C%20and%20retention. Taylor, K. (2016). Using shared governance to empower nurses. Nursing Times; 112: ½, 20-23. Retrieved from https://www.nursingtimes.net/clinical-archive/leadership/using-shared-governance-to-empower-nurses-11-01-2016/
- 28. Note: These slides are uploaded for information purposes and as a partial requirement of Philippine Women's University in Ph.D. class; Subject: Governance in Health Care Practice.