Shared Governance

bellehill, RN · Feb 10, 2011

Our unit has a shared governance with 4 different quadrants: customer service, quality of worklife, practice and research, and education. Each quadrant has a chair and co-chair as well as the chair and co-chair of the shared governance. Ours meets once a month for 2 hours. We have bylaws and a mission statement.

The basic reason for shared governance is to bring decision making to the bedside, especially when it affects the bedside nurse. Some topics we have covered; weekend on-call for staffing, new education topics, social events for staff gatherings, signage for our visitor waiting room, new protocols for patient care.

You really have to have a 100% commitment from the chairs and co-chairs for it to work. You also have to have a manager who believes in the process and is willing to let the council make decisions. Ideally, the chairs and co-chairs of each quadrant would engage the staff to be involved. All decisions are taken to the staff and decided by a vote so even if someone can't make it to the meeting their voice is heard.

There are several great resources on-line regarding shared governance. It is very slow to develop but once you can get a strong base it will be worth it.

ICURN13 · Feb 10, 2011

Thanks so much for sharing. Do you have any websites for reference that would be helpful?? Thanks again!

MunoRN, RN · Feb 10, 2011

My hospital has had a 3R committee for 5 years, a practice council and a quality council for 2 years, and started education and research councils a few months ago. This is my hospital's 3rd go around with a shared governance model since the idea was first introduced in the late 70's/ early 80's.

In theory, Shared Governance has a lot of potential, in practice very few shared governance models have survived more than 10 years, and research into the effectiveness of Shared governance has shown little benefit in achieving it's goals. Because of this, I would keep this in mind when looking at the traditional in models, remembering we still really don't know how to make this work, if anything the traditional models are most useful as "how not to do Shared Governance" lesson.

When we decided to try Shared Governance again we decided to spend some time trying to identify why it so often doesn't work.

Some of the more straight forward reasons were:

When Shared Governance is implemented mainly to satisfy the requirements of your Magnet Status application.

When administrators/managers are the main proponents and organizers of Shared Governance; Shared Governance has to earn the trust and respect of staff nurses, which won't happen if there is even the slightest hint that it is just a puppet government for the administration to push through it's projects.

The most popular model is still the Bob Hess/Porter O'Grady model which emphasizes that the goal of Shared Governance is increasing Nursing's share of power. Shared Governance tends to succeed when it focuses on improving patient care and the Nurse's ability to facilitate better care, making it a petty ploy to grab power tends to cause it self destruct.

It requires a huge time commitment to work well: Our current practice council meets once a month for 8 hours and has 30 hours a month budgeted for project work outside of meetings. Our organization wide practice council meets monthly for a 2 day face to face meeting as well as conference calls in between.

Shared Governance has to deal with things that actually matter, limiting your scope to what kind of cake to get for Nurses Day doesn't sufficiently justify your existence to floor nurses.

Shared Governance can't demand too much, but it has to be assertive enough for others to take it seriously. If another group or department puts out anything that directly affects Nursing care, make sure they know it needs to go through the appropriate council; NO exceptions.

Shared Governance can't isolate itself by focusing only on Nursing specific issues; most issues that effect patient care involve multiple influences - MD's, RT's, etc. One of the longest lasting Shared Governance models is not a Nursing group specifically but is made up of "patient care councils" that include representatives from all aspects of patient care.

The main source for Shared Governance info is Robert Hess's website: sharedgovernance.org

Here is a review of the history and effects of Shared Governance: http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume92004/No1Jan04/SharedGovernanceModels.aspx

Another is here: http://journals.lww.com/jonajournal/Abstract/2010/10000/Factors_Associated_With_Success_and_Breakdown_of.5.aspx (membership required)

There is another systemic review of all the research done on Shared Governance that is much better but I can't find it right now, I'll keep looking.

bobhess · Feb 10, 2011

If there's another good lit review on shared governance (I had one in my dissertation, but it's old), I'd love to see it. I might be able to contact the author and post in on the Forum for Shared Governance's site.

RN1980 · Feb 10, 2011

ha! that would never work at my hospital...sounds cool though.

MunoRN, RN · Feb 11, 2011

If there's another good lit review on shared governance (I had one in my dissertation, but it's old), I'd love to see it. I might be able to contact the author and post in on the Forum for Shared Governance's site.

Is this really Robert Hess? If so, I apologize for forgetting to include this article: http://www.nursingworld.org/mods/mod680/update.pdf

The best comprehensive review of Shared Governance I have printed out somewhere but I can't remember how I found it online, I'll keep looking.

ICURN13 · Feb 11, 2011

Thanks to all for sharing. This has been a great help!!

whynursing · Sep 16, 2011

great posts about Shared Governance. I work in an ICU and we have a new director ( 2 years ) who does not practice Shared Governance and we are Magnet...intersting....Our committees are on paper only.. recently she instituted major changes and never had a unit vote on the topic. so once again moral is low again and staff are unhappy.