One way to empower nurses to provide consistent, high-quality care, reduce chronic stress and burnout, and stay motivated is to implement a shared governance model of nursing. In this article, we discuss what shared governance in nursing is and how it benefits nurses, organizations, and patients. We also provide a shared governance implementation roadmap for nursing leaders, which highlights just how a structured path engages nurses in decision-making and boosts retention amid staffing shortages.
What is Shared Governance in Nursing?
Shared governance in nursing refers to a collaborative structural model that encourages nurses to express and manage their work with a high level of professional autonomy, ownership, engagement, and accountability.
With shared governance, all nurses — from the unit-level bedside setting to the higher-level nursing management — participate in decision-making processes that affect resources, staffing, and patient care. This allows the nurses on the floor, the ones who work the closest to patients, to be directly involved in creating policies and protocols.
For shared governance to materialize, communication, transparency, and collaboration must be heavily promoted at all levels of and across different teams within the organization. This means that for a healthcare organization to adopt a shared governance model, it must integrate all these vital elements into the workplace culture.
The Benefits of the Shared Governance Model
The following are the positive outcomes associated with the adoption of the shared governance model:
- Patients receive higher-quality care. Studies show that when hospitals adopt a shared governance framework, patients experience fewer catheter-associated urinary tract infections, hospital-acquired pressure ulcers, and central line-associated bloodstream infections.
- Improved job satisfaction among nurses, which leads to better attendance and retention rates.
- Bolstered communication and collaboration across various healthcare teams.
- A clearer path toward leadership roles for nurses.
- Cost savings to healthcare organizations. When nursing turnover rates are low, healthcare organizations save millions of dollars on hiring and training new staff members.
Key Components of the Shared Governance Model
Some of the core elements of the shared governance model include:
- Unit-based councils (UBCs): UBCs are groups comprised of various volunteer nurses, both at the bedside and leadership levels, who can help detect unit-specific challenges, recommend plans to address them, integrate changes in workflows, and ensure that changes are properly implemented and continuously assessed.
- Interdisciplinary committees: The creation of interdisciplinary committees, composed of healthcare professionals from various teams (e.g., a team composed of nurses, physicians, pharmacists, and rehabilitation specialists), reduces error rates, limits miscommunications, and shortens hospital stays. When healthcare professionals from different teams are communicating and collaborating actively, patients receive data-driven, holistic, and high-quality care, which greatly contributes to high patient satisfaction levels.
- Feedback loops: When changes are made to current systems and workflows, it’s vital to regularly evaluate them to see if they should be reinforced and sustained, or if they need to be tweaked or stabilized.
Shared Governance Implementation Roadmap
- Assessment Period: The assessment period takes about a month or two to complete, where UBCs conduct surveys and evaluations to determine strengths, weaknesses, opportunities, and threats. Pain points to be addressed are categorized based on priority levels.
- Planning: In the third and fourth months, the planning period ensues. Based on the challenges identified, the shared governance committee can start drafting bylaws that will list the council’s scope and limitations, as well as the proposed changes to workflows and operations. Roles will also be listed, and their respective responsibilities.
- Launch: In the fifth and sixth months, representatives for each team across all levels should be elected. During the launching period, kickoff events and training sessions are held to ensure that everyone understands how the shared governance framework works, what will change, how communication should be done across interdisciplinary teams, and how their roles work in the new model.
- Integration: In the seventh to twelfth months, the shared governance model is rolled out. Everyone is empowered and encouraged to perform their new roles, and data is recorded for monitoring and assessment purposes.
- Sustain: The council conducts quarterly and annual audits of system and process changes to see what should be sustained and what needs to be changed.
