Shared governance has become a buzzword in healthcare, especially in regard to meeting excellence standards such as the Magnet Recognition Program.
Despite this rise in popularity, shared governance may be an important step on the path toward better patient outcomes, increased job satisfaction, and streamlined workforce planning. Discover what shared governance means in nursing and what benefits it provides to facilities, staff, and patients.
What is shared governance?
Shared governance is a decision-making system that involves multiple groups with vested interests in an end result.
As the term indicates, shared governance aims to build joint responsibility, shared vision, and collaborative partnerships. Shared governance councils will typically make decisions regarding practice standards, quality improvement, professional development, and research.
This model’s nature of shared responsibility, teamwork, and focus on healthcare outcomes improve patient experience and staff satisfaction.
The following are the main principles and characteristics of shared governance:
- Accountability
- Autonomy
- Empowerment
- Innovation
- Leadership
- Ownership
- Practice equity
- Team building
What is shared governance in nursing?
In nursing, shared governance promotes joint decision-making between bedside nurses and nurse leaders. It shifts the focus from a hierarchical management style to a collaborative model involving the administrative team and bedside nurses. These joint decisions encompass healthcare issues such as the following:
- Evidence-based practice projects
- New equipment purchases
- Use of resources
- Staffing
- Nursing research
Although shared governance may be considered a nursing model, it is also an interdisciplinary process involving various professionals within healthcare settings to identify issues and find solutions.
Benefits of implementing shared governance in nursing
The hype around shared governance is not unfounded. By inviting nurses to conversations about nursing challenges and policy, this model offers significant advantages for healthcare organizations, staff, and patients.
Improved patient outcomes
Shared governance promotes the active engagement of the healthcare team, which, in turn, improves patient outcomes.
Numerous studies have found improved patient outcomes in the following areas after introducing shared governance structures and processes:
- Catheter-associated urinary tract infections
- Central line-associated bloodstream infections
- Falls with injuries
- Hospital-acquired pressure ulcers
Examples of the success of shared governance in nursing were published in the study published by the The Online Journal of Issues in Nursing titled, “Increasing Quality and Patient Outcomes with Staff Engagement and Shared Governance.”This study took place at a suburban community hospital with approximately 200 beds. Nurses created fall prevention plans for targeted patient populations at the nursing governance and unit levels. Total patient falls decreased from 2.65 to 1.22 per 1,000 patient days and remained under the national average. Patient falls with injury also reduced to below the national average.
Awareness of the positive effect of shared governance on patient outcomes encourages nurses to be involved in this collaborative work model.
Improved nurse job satisfaction and retention
Nursing shared governance is an essential aspect of the Magnet Recognition Program. According to the American Nurses Credentialing Center (ANCC), hospitals with Magnet designation achieve the following:
- Higher nurse job satisfaction
- Lower nurse burnout
- Lower registered nurse (RN) turnover
Shared governance leads to more empowered nurses. Empowered nurses have autonomy and competency to perform work requirements successfully. They believe that their work is important and that they have a strong influence over their work environment.
Creating and supporting a process that allows for innovation prevents stagnation, encourages growth, and improves outcomes. Nurses are more engaged in policy development and revision. They are also more satisfied seeing their ideas implemented within patient care improvement projects.Overall, shared governance in nursing fosters a sense of belonging and loyalty to nurses’ healthcare organizations, which improves performance and increases nurse retention.
Optimized workforce planning
The joint decision-making between bedside nurses and nurse leaders facilitates optimal staffing practices. As nurses will typically see the immediate effects of understaffing, they should be key partners in proposing solutions that best integrate with their daily workflows.
For example, shared governance councils can analyze patient census trends and make decisions regarding nurse recruitment needs. They are also free to explore innovative staffing strategies, such as digital per diem staffing platforms, to adapt to fluctuating needs and reduce nurse understaffing.
Increased interdisciplinary collaboration
Collaboration is the cornerstone of shared governance.
Healthcare facilities with shared governance programs institutionalize collaboration not only between bedside nurses and nurse leaders but also across disciplines. An interprofessional shared governance structure brings together healthcare professionals from different disciplines to collaborate in decision-making and improve the functioning of a healthcare organization. This collaborative approach aims to reflect the expertise and perspectives of all disciplines to improve patient care.Healthcare professionals involved in interprofessional shared governance include the following:
- Nurses
- Physicians
- Pharmacists
- Allied health workers
Interdisciplinary shared governance structures are key to employee engagement. Several studies have found an association between shared governance and workplace empowerment, job satisfaction, and staff engagement, particularly in quality care initiatives.
Best practices for implementing shared governance
Any change is challenging. Healthcare organizations must be realistic regarding the time and other resources necessary to implement a shared governance structure successfully. Here are some important strategies for the implementation of a successful shared governance model in your facility.
1. Engage staff and promote participation
Healthcare facilities that wish to implement shared governance programs must educate staff about the process and involve bedside nurses from the start. Healthcare professionals must understand how shared governance works and how it benefits staff and patients. Involving nurses from the beginning is essential to build trust in the process, confidence in nurses’ abilities, and ownership of the shared governance model.
2. Create clear governance councils and committees
A vague ideological support of multidisciplinary collaboration is not the same as establishing a shared governance structure. Healthcare organizations must develop a clear vision of a workable shared governance model.Unit-level councils must support councils at the organizational level, and organizations must develop leaders to oversee the shared governance councils.
3. Create a comprehensive implementation plan
The shared governance model must extend to encompass all aspects of inter-professional collaboration and healthcare delivery. For example, organizations must make provisions for involving off-shift nurses, such as those who work nights and weekends. To this end, shared governance council meetings could be held at night—at least every few months.
4. Provide opportunities for open communication
A common understanding of the meaning of the shared governance process is essential to ensure that everyone is on the same page. Open communication among team members can prevent and overcome barriers to successful implementation.
Frequent check-ins and clarification meetings are important during planning phases, ensuring that proposed solutions are implemented so they achieve the intended result. Creating frequent opportunities for open communication allows staff to address concerns, offer suggestions, and reach a group consensus. Clear communication improves teamwork, patient safety, and trust in the process.
5. Continuously identify areas for improvement
Growth and innovation are inherent aspects of shared governance. The model implies a continuous evaluation of the structure’s success and evolution.
Assessments for evaluating the success of a shared governance structure include the following:
- National Database of Nursing Quality Indicators (NDNQI)
- Practice Environment Scale of the Nursing Work Index (PES-NWI)
- Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS)
These assessments provide the necessary data for continued evaluation and performance improvement planning. Furthermore, following the Plan-Do-Study-Act (PDSA) improvement cycle aids organizations in developing sustainable policies and procedures during the shared governance planning, implementation, and evaluation stages.
Embrace innovative trends in your healthcare facility
Hospitals and other healthcare facilities struggle to attract and retain nursing staff. Healthcare organizations must be proactive in implementing innovative nursing models, policies, and staffing strategies that improve nurse job satisfaction and patient outcomes. One such action is implementing a shared governance model by bring nursing staff in to design a tailored staffing strategy.
Discover other helpful articles for healthcare facility administrators on addressing staffing challenges, improving work culture, motivating staff, and keeping current on industry trends.
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